A myocardial revascularisation procedure was carried out on 68 patients with obstructive atheroma of the coronary arteries associated with severe angina pectoris. In 58 cases a total of 97 vein grafts were used, and in 10 cases the internal mammary artery was anastomosed to the anterior descending artery (using a vein graft in 5 of them). Before operation the patients had selective coronary arteriography, and a maximal exercise test using a bicycle ergometer. Three months postoperatively the patency of the coronary by-pass was checked, and a further exercise test completed. In the exercise test the criteria were the appearance of angina pectoris, improved performance (measured by the duration of exercise, the maximal power, and the heart rate at the end of exercise), and improved ECG findings. These criteria were correlated by the patency of the graft or grafts as noted at arteriography. There was no pain on exercise in 55 patients (81 per cent), the performance improved in 37 (54 per cent), and the ECG findings improved in 50 (72 per cent). At angiography, 34 patients (50 per cent) had a completely patent by-pass (group I), 31 patients (45.5 per cent) had at least one patent graft (group II), and 3 patients (4.4 per cent) had no patent graft (group III). Group I corresponds to 31 good or very good results and to 3 states on non improvement; group II contains 22 good results and 9 states of non improvement; group III corresponds to 3 states of non improvement. Exercise demonstrates the results of myocardial revascularisation surgery; the correlations between these results and those of graft patency justify its use in surveillance of coronary patients who have been operated. Exercise tests show that the best results are obtained in patients with severe functional disturbances and whose ventricular cinetics have remained sufficient.

Adult↗

PubMed1975

[Coronary anastomosis. Angiographic study and statistical correlation in 140 patients with angiogenic coronary atheroma].

A great number of studies devoted to coronary artery anastomoses on the experimental animal or on post-mortem material, while the in vivo studies are relatively rare. The results of these studies are often contradictory, and many questions are still unresolved concerning the part played by the anastomoses in natural history of coronary artery atheroma. On 140 patients, all suffering from angina due to coronary atheroma, a study of the anastomoses visible on coronary arteriograms was undertaken, together with a statistical analysis of the various correlations between the presence or not of coronary artery anastomoses and the various criteria, anatomical, clinical and electrocardiographic.

Adult↗

PubMed1975

[Congenital abnormalities of origin or distribution of the coronary arteries arising from the aorta].

The authors report 16 cases of this type, without associated cardiac abnormality, seen in the course of 3000 coronary arteriographies in adults. The diagnosis has been made on the findings at selective coronary arteriography, completed eight times by one totalinjection above the sinus. A classification of distribution anomalies and of cases of hypoplasia of one coronary artery is put forward, based on the number of ostia. The role which these anomalies might play in the genesis of myocardial ischaemia is discussed, and was formally considered responsible in two cases. It has not been demonstrated that they play a part in the development of atheromatous stenosis of the coronary arteries. It is vital that these anomalies should be recognized preoperatively.

Adult↗

PubMed1974