الفهرس 
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Abstract
Patients (62%) had angina class iii and 14 patients (28%) had angina class iv. Ten patients (20%) had dyspnea class i, 24 patients (48%) had dyspnea class ii and 16 patients (32%) had dyspnea class iii. 9 patients (18%) had palpitation. 11 patients (22%) had easy fatigue. Operative complications recorded was in the form of ventricular tachycardia in 2 patients (4%), af in 4 patients (8%) which was treated with dc and bleeding in 5 patients (10%) and this was not serious and controlled with stitching of the bleeding site. Post-operative in-hospital course: only one patient died 2 days after the operation because of sustained vt and myocardial infarction. Heart failure occurred in 2 patients (4%), frequent pvcs in 10 patients (20%) and non-sustained vt in 3 patients (6%).cardiovascular mortality: 1 patient (2%) died after 1 month, 2 patients (4%) died after 1- 3 months and 1 patient (2%) died 3 – 6 months after the procedure. The overall mortality rate was 5 patients (10%) at the end of follow-up period.cardiovascular adverse events during the follow-up period: 2 patients (4%) developed heart failure after 1 month, and 3 patients (6%) developed heart failure at the end of follow-up period. 1 patient (2%) admitted because of mi after 1 month and 3 patients (6%) between 3-6 months. 2 patients (4%) had unstable angina 1-3 months after the procedure and another 2 patients (4%) had unstable angina 3 – 6 months after the procedure. One patient (2%) had completed heart block and required permanent pacemaker implantation. Symptomatic assessment before and the 3 periods of follow-up after tmlr: there was significant improvement in the severity of angina as assessed by canadian cardiovascular society grading after the procedure and the improvement was most significant after 3 months and then declined slightly after 6 months but still significant in comparison to the pre-procedural values (p < 0.05). Also, there was significant improvement in the grade of dyspnea as assessed by the new york heart association functional dyspnea class and the most significant improvement was after 3 months and the degree of improvement decreased but still significantly better than the pre-procedural values (p < 0.05). Exercise test characteristics before and after tmlr: there was no significant change in the resting hr, resting systolic bp, resting diastolic bp and peak diastolic bp (p > 0.05). After tmlr there was significant improvement in the exercise capacity, exercise duration, peak hr, peak systolic bp and decrease in the incidence of angina durind exercise (p < 0.001). Stress thallium spect: the total number of segments evaluated by thallium was 1000 segments (20 segments for each patient). Results of the study showed that there was significant improvement in the number of the normal segments 6 months after the procedure (p < 0.05). Dobutamine stress echocardiographic study: results of the current study regarding different segmental response before and after tmlr showed that after the procedure 68% of the segments that showed biphasic response recovered after tmlr and (32%) remained unchanged, 22% of the segments that showed sustained improvement recovered and 78% remained unchanged, 27% of the segments that showed no change before tmlr showed recovery while 73% of these segments remained unchanged and 74% of the segments that showed worsening before tmlr recovered while 26% of these segments remained unchanged. Results of the current study regarding wall motion score index at different levels of dobutamine infusion before and after tmlr showed the resting mean score was 21.4 ±2.19 before tmlr and became 19.2 ± 2.21 after tmlr and this difference was significant (p < 0.001), at low dose dobutamine the mean score was17.9 ± 1.78 before tmlr and became 17.2 ± 2.27 after tmlr and this difference was no significant (p > 0.05), at intermediate dose dobutamine mean score was 18.87 ± 2.73 before tmlr and became 17.4 ± 2.89 after tmlr and the difference was significant (p < 0.01) and at peak dose dobutamine the mean score was 20.13 ± 2.67 before tmlr and it became 17.53 ± 2.92 after tmlr and the difference was significant (p < 0.001).