Percutaneous coronary laser thermal angioplasty was successfully performed on a 57‐year‐old white male with a total occlusion of the left anterior descending coronary artery. The patient was the recipient of an orthotopic heart transplant 3 years previously secondary to end‐stage heart disease due to idiopathic dilated cardiomyopathy. The lesion was reduced from 100% to 33% residual stenosis following a single 4‐second pulse of 12 W of continuous wave Nd:YAG (neodymium:yttrium‐aluminum‐garnet) laser energy delivered to a distal thermal probe. Conventional balloon angioplasty reduced the remaining stenosis to 22%, without evidence of vessel perforation, spasm, dissection, or embolization of debris. This case represents the first known use of thermal laser energy as an adjunct to conventional angioplasty for the treatment of coronary artery disease in a heart transplant recipient. Additional studies are indicated to determine the clinical role of this procedure in relation to established methods of revascularization for the treatment of accelerated transplant athe