For a critical evaluation regarding surgical therapy of coronary heart disease, we quote from important publications to the following points: Early mortality due to surgical treatment, by estimating the severity of the disease as determinated by the criterions of the New York Heart Association, or by the number of the diseased coronary vessels, or by important parameters of the function of the left ventricle (0% to 12%). Frequency of acute myocardial infarction, intra-or postoperatively (10% to 15% of the survivers, 50% of the lethal cases). Frequency of occlusion, of an aorto-coronary saphenous vein bypass (up to 30%). Amelioration of ischemic heart pain by surgical treatment (up to 90%). Prevention of the progression of coronary heart disease (not proved). Natural history of patients with coronary heart disease without surgical treatment, by estimating the number of the diseased vessels (2% for one-, 6% for two-, and 10% for three vessel diseases; 30% mortality rate due to stenosis of the left main coronary artery). Comparison of the mortality rates of surgically treated patients against those without surgery for coronary heart disease with equal severity (no difference). We investigated the connection between the severity of coronary heart disease (determinated by coronary angiography), and the mortality rate in our own patient material. A fundamental conformity appeared, with the results as quoted in the literature. Finally we difined the indications for surgical treatment of coronary heart disease due to angina pectoris, which cannot be managed conservatively and which makes a normal live difficult or impossible. Moreover, the function of the left ventricle should be fairly good. An absolute indication is a stenosis of the left main coronary artery.

Angina Pectoris↗

PubMed1976

[Progress in the treatment of acute myocardial infarct. II].

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Acute Disease↗

PubMed1976

[Progress in the treatment of acute myocardial infarct].

The ultimate causes which lead to acute myocardial infarction are invariably unknown. Accordingly there are also considerable controversial points of view with regard to an aggressive management. Futhermore, concerning the attempts to subdue the primarily developing myocardial necrosis, anticoagulant therapy and fibrinolysis have shown to be ineffective. Their beneficial effect is based only on a secondary hemodynamic improvement. Therefore, present therapy remains principally defensive. It consists in prevention and treatment of complications which either immediately threaten the life of the patient or deteriorate their long-term prognosis by extention of the primary necrosis. All these parameters are thoroughly discussed, especially the use of new antiarrhythmic drugs and the management of cardiogenic shock. However the latest trends of therapy again show a change towards a more aggressive attitude, particularly in attempts to prevent the secondary extention of infarction. The developing acute myocardial infarction should be kept as small as possible. This can be achieved by hemodynamic interventions which reduce cardiac work and oxygen consumption. Principally this is a matter of pharmacological reduction of ventricular afterload and of mechanical assistance utilizing the intra-aortic balloon pump. Finally also the present possibilities of "acute coronary surgery" are delineated, i. e. surgical measurements against impending and developing acute myocardial infarction and its complications.

Acute Disease↗

PubMed1976