Biomedical subjects
Publications and source records attributed to E Sivertssen.
A series of 414 selective coronary arteriographies in 322 patients has been done at Ullevål Hospital from May 1971 to Jan. 1974. Judkins technique was used in all cases. The indications for arteriography, the diagnoses as regards the coronary arteries, the therapeutic consequences,and the complications of selective coronary arteriography are described.
In the 3-year period from May 1971 to April 1974, 90 patients had aortocoronary bypass for angina pectoris at Ulleval Hospital. One patient died shortly after the operation (operative mortality 1.1%). There were no further deaths in the observation period. Clinical improvement was seen in 93% of the patients, early shunt patency in 92%. The study suggests that patients with isolated affection of the right coronary artery should not have bypass, because these patients 1) had less severe symptoms, 2) had better preserved left ventricular function, and 3) seemed to have a smaller chance of benefiting from the operation than the other patients. Multiple shunts gave good clinical results and carried no higher surgical risk than did single shunts. Good clinical results were seen also in patients with occluded shunts provided they had at least one patent shunt too. Graft occlusion occurred early and was associated with low graft flow as measured intraoperatively. Graft occlusion was not usually followed by demonstrable myocardial necrosis. In view of the small operative risk and the high score of symptom relief it is concluded that all patients with angina pectoris that does not readily respond to medical treatment, should be considered for aortocoronary bypass.
Sinus node recovery time (SRT) after rapid atrial pacing has been recorded in 66 patients, 28 with coronary heart disease, 11 with advanced AV block, 10 with sick sinus syndrome and 17 with paroxysmal tachyarrhythmias. In patients with a normal functioning sinus node SRT was related to the basal heart rate. On an average SRT was 130% of the basal P-P interval with an upper limit of 160%. In patients with a presumed normal atrial function the mean SRT was found to be 1 080 msec, with an upper limit of 1 500 msec. This corresponds with previously published observations. In all 5 patients examined, beta-receptor blockade (propranolol 5 mg i.v.) prolonged SRT. The prolonged SRT was related to sinus bradycardia. Verapamil (Isoptin 5 mg i.v.) had no effect on SRT in the 7 patients examined. The observation of an SRT of more than 1 500 msec indicates a poor sinus node function. Recording of a normal SRT, however, cannot exclude a sinus node dysfunction, as normal SRT is occasionally found even in patients with a clinically proved dysfunction.
This paper presents the long-term results of 221 thrombendarterectomy operations during the period 1955-61, and of 86 femoro-popliteal venous bypass operations during the period 1961-64. The indication for surgery was in the majority of the patients disabling claudication. When pain at rest or ulceration was present, arterial reconstruction was performed even when the outlook for a lasting result was poor. Preoperatively a major amputation seemed inevitable in 31 limbs. Thirteen of these are considered to have been saved by the operation. After aortoiliac thrombendarterectomy patent arteries were found in 80% of the extremities after one year and in 48% after 10 years. Forty-five per cent of the extremities were patent on re-examination or remained patent until death. After fermoro-popliteal thrombendarterectomy, 61% of the arteries were patent after one year and 26% after 10 years. Thirty-nine per cent of the arteries were patent on re-examination or remained patent until death. After femoro-popliteal venous bypass, 88% of the grafts were patent after one year and 58% after 5 years. Forty-nine per cent of the grafts were patent on re-examination or remained patent until death. The postoperative mortality was small (4.4% after aortoiliac surgery and 2.0% after femoro-popliteal surgery), and mostly caused by widespread atherosclerosis in other parts of the arterial system. On re-examination 8 to 16 years after the operation, 63% of the patient were dead. Almost 50% of the deaths were caused by coronary heart disease, 17% by cerebrovascular catastrophes, and 13% by other manifestations of atherosclerotic disease. The results are discussed, and it is concluded that long-term results after vascular surgery may be favourable. Peripheral atherosclerosis is, however, a local manifestation of a generalized disease. The indications for reconstructive arterial surgery should therefore be relatively restricted.
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