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Miling Address: Mário Sérgio Soares de Azeredo Coutinho • R. Dr. Percy João de Borba, 129 88036-200 – Florianópolis, SC, Brazil E-mail: mcoutinho@cardiol.br Manuscript received March 28, 2006; revised manuscript received May 1, 2006; accepted May 18, 2006. Since 1933, when Wearn et al1 described a sinusoidal network in the human heart, some forms of indirect myocardial revascularization have been proposed in an attempt to improve cardioischemic symptoms. In 1935, Beck2 developed the cardio-omentopexy, in which the omentum was sutured to the heart with the objective of increasing its perfusion. In 1946, Arthur Vineber3, a Canadian surgeon, proposed the direct implantation of the internal thoracic artery on the myocardium as a form of reestablishing the coronary flow in patients with angina. Due to inconsistent results and the development of direct coronary artery revascularization techniques this procedure was gradually abandoned. In 1965, Sen et al4 proposed the creation of transmural channels in the left ventricular wall to enable the direct perfusion of the ischemic myocardium with oxygenated blood from the LV. This concept was based on reptilian hearts, in which the left ventricle is directly perfused by endothelium-lined channels radiating from the ventricular cavity. In the 1980’s, the “cardiac sinusoids” concept was resumed and the laser revascularization era began5,6. Using carbon dioxide or Holmium Laser (Light Amplification by Stimulated Emission of Radiation), the myocardium of a supposedly ischemic area was perfused with the objective of increasing perfusion and decreasing symptoms in refractory angina. Channel opening using laser was histologically investigated, and there is no evidence that they remain patent after the procedure. On the contrary, they are almost immediately filled with cells and blood and, thus, blocked. Other mechanisms hypothesized to explain the effect of laser in the improvement of angina are neoangiogenesis, cardiac sympathetic denervation7, in addition to the procedural placebo effect. The first two are also hypothetical and there is no definitive proof that they have any effect on the process of improvement of anginal symptoms. The placebo effect is another possibility that will be discussed further on.

Alta tecnologia e efeito placebo: o caso da revascularização miocárdica a laser no tratamento paliativo da angina do peito refratária