Transmyocardial Laser Revascularization and Cardiovascular Magnetic Resonance Imaging

Inclusion Criteria: * Male or female 18 years of age or over * Patients with medically refractory, severe, class III or IV angina based on the Canadian Cardiovascular Society angina scale as determined by a physician * Ejection fraction 25% or greater * Patients with significant ischemia in the myocardium and who are NOT candidates for treatment by direct coronary revascularization methods (i.e., CABG or PCI) * Ability and willingness to consent and Authorization for use of PHI Exclusion Criteria: * Patient cannot undergo a surgical procedure or general anesthesia * Patient not eligible for CMR study * Severe unstable angina * Q-wave MI within 3 weeks prior to TMR * NQWMI within 2 weeks prior to TMR * Decompensated heart failure (class III/IV) at the time of procedure * Known increased bleeding risk * Implanted pacemaker or defibrillator * Clinically unstable arrhythmia * Not able or willing to adhere to the study tests and procedures * Inability or unwillingness to consent and Authorization for use of PHI