Nifedipine is a potent vasodilator. Until now, its positive effect on cardiac performance after coronary artery bypass graft (CABG) operation was interpreted as the result of a decrease in the afterload. So as to have a better understanding of the precise role of nifedipine under these circumstances, an investigation was carried out on 20 patients, at the end of the CABG operation. Cardiac output (CO), CABG-flow to left anterior descending artery (LAD), mean aortic pressure (AP), mean left atrial pressure (LAP) systemic vascular resistances (SVR), LAD resistances and electrocardiogram (ECG) were recorded at the end of cardiopulmonary bypass (Step 1). Thereafter, a bolus of 0.1 mg nifedipine was injected directly through the CABG to LAD. The same measurements as above were recorded 1 min (Step 2), 4 min (Step 3), and 9 min (Step 4) later, respectively. The most striking results were an average increase of coronary flow of 120% at step (S) 2, and a decrease of mean LAP of 18.9% at S 3. A slight but significant decrease of AP (11% in average) could be observed at S 2-3. No significant effect on CO and peripheral SVR could be noted in the first nine minutes after injection of nifedipine. Decrease of coronary vascular resistance was the earliest and perhaps the most important alteration. It caused an increase of coronary perfusion, improvement of myocardial relaxation and performance followed by a reduction of LAP. The absence of ST alteration in the ECG was representative of a flow which effectively passed through the coronary capillaries, without significant A-V shunt.

Blood Pressure↗

PubMedDate not supplied

Combination of mitral and coronary artery surgery.

Between 1977 and 1984, 63 patients had an aortocoronary bypass combined with mitral valve surgery. The age of patients varied from 36-72 years. Patients were assigned to 2 groups depending on the aetiology of the mitral valve disease. In group A (42 patients) the aetiology was rheumatic or congenital, in group B (21 patients) the mitral disease was secondary to ischaemic heart disease. In all but one patients the mitral valve was replaced by a prosthesis. A similar number of bypass grafts ranging from 1 to 5 was done in each group. Hospital mortality was 2.3% (1 patient) for A and 9.5% (2 patients) for B. Major causes of morbidity were low cardiac output (5% for A and 4.8% for B), myocardial infarction (4.8% for B) as well as multiple organs failure (4.8% for B). Follow-up averaged 2.7 +/- 2.0 years (0.4-7 years). Linearized (%/patients-years) mortality was 2.6 and 4.9 for A and B, respectively. Thromboembolism occurred at a rate of 2.6 for A and 4.8 for B; myocardial infarction at a rate of 1.3 for A and 0 for B. Functional improvement was similar for the two groups (1.3 +/- 0.7 classes for A and 1.6 +/- 0.6 for B). Four-year actuarial survival was 0.93 and 0.73 for A and B, respectively. Although no significant difference could be found between groups A and B, it seems that attrition rate is somewhat more favourable for group A than B. The small increase in risk compared to the significant improvement supports the policy of the combined approach of mitral valve and ACBG surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Renal transplant: remote results and role of the gastrointestinal complications].

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Adolescent↗

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[Metabolism of some amino acids in uremia].

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Amino Acids↗

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Flow characteristics in single and sequential aorto-coronary by-pass grafts.

Thirty five patients, operated upon with an aorto-coronary by-pass graft to left anterior descending artery and to a major diagonal branch, were prospectively analysed. The patients were divided into two comparable groups, in whom a single graft technique and a sequential graft technique was used respectively. Flows through the by-passes were measured electromagnetically during the operation. Flow to left anterior descending artery was significantly higher through an isolated by-pass than through a sequential by-pass. Flow to diagonal branch showed no significant difference in the two groups. The resistance of the intramyocardial coronary bed of the left anterior descending artery was lower with single than with sequential by-pass technique, while no difference existed between the resistance of intramyocardial coronary bed of the diagonal branch with both techniques. Blood velocity was higher in single by-pass to the left anterior descending artery than in the peripheral segment of sequential vein graft directed to the anterior descending artery.

Blood Flow Velocity↗