Despite increasing enthusiasm about the treatment of symptomatic angina pectoris by direct revascularization surgery, there appropriately continues to be concern about the effects of such therapy. While it is generally accepted that surgery is effective in relieving anginal pain in upwards of 80% of patients undergoing aortocoronary bypass, reservations focus on the possibilities that such therapy may increase the incidence of infarction (postoperative), accelerate the atherosclerotic process, and shorten longevity, primarily because of the increased early operative mortality. While these contentions may or may not be true for the majority of patients who undergo such therapy, there is accumulating experience that in certain well-defined subsets, surgery does favorably affect the prognosis of the disease. Patients with preinfarction angina constitute one such subset of patients with coronary atherosclerosis. The all-inclusive surgical mortality for 106 consecutive cases was 3.8%, and 86% of the survivors are asymptomatic. Actuarial analysis of follow-up data reveals that this survival rate is essentially constant through the first 36 months after surgery. On the basis of this experience we feel that patients with preinfarction angina present a therapeutic opportunity in which the ideal goal of preventive medical care can be achieved by early identification, study and surgery.

Adult↗

PubMedDate not supplied

Bradyarrhythmias requiring pacemaker implantation after orthotopic heart transplantation: association with rejection.

Patients with severe sinus-node dysfunction that required pacemaker implantation after orthotopic heart transplantation were reviewed. During a 21-month period, 42 transplantations were performed in 41 patients. Five patients (12.2%) required a permanent pacemaker because of severe dysrhythmias. Three patients had moderate-to-severe cellular and/or humoral (vascular) rejection, and two of the five patients (40%) died. In the remaining two patients, bradyarrhythmias were due most likely to trauma to the sinus node during harvesting of the donor heart, and these patients have shown no evidence of significant rejection on repeated biopsies. A strong relationship was found between moderate or severe rejection and the development of significant bradyarrhythmias that required the placement of a permanent pacemaker. The development of severe dysrhythmias during the early or late posttransplantation period should be considered a manifestation of an ongoing rejection episode until proven otherwise. In our experience this evidence of rejection may imply a poor prognostic sign because it is associated with high mortality rates.

Adult↗