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At least 91 records · Page 5Linked to original sources
PubMed2005

Optimal method of coronary endarterectomy for diffusely diseased coronary arteries.

BACKGROUND: Although several techniques for coronary artery bypass grafting have been introduced that incorporate coronary endarterectomy (CE), there is little information about late patency among the various CE methods. To clarify the quality of CE, we assessed clinical and angiographic results of our experience with this procedure on 127 patients who had diffusely diseased coronary arteries. METHODS: Between January 1994 and December 2002, 127 patients underwent coronary artery bypass grafting with CE. Sixty-eight patients undergoing CE with long arteriotomies and on-lay patch bypass grafting (group O) were compared with 59 patients undergoing CE with the conventional pull-out method (group P). RESULTS: Thirty-day mortality was 2.9% in group O and 6.8% in group P. The early angiographic results of 115 patients revealed a patency rate of 92.1% (grade A: 79.4%) in group O and 88.6% (grade A: 68.6%) in group P. Actuarial survival at 5 years was 90.7% in group O and 74.0% in group P (p = 0.1). Angiograms performed on 78 patients after a mean period of 21 +/- 16 months showed a patency rate of 89.1% (grade A:76.1%) in group O and 81.0% (grade A: 38.1%) in group P (grade A: p < 0.001). CONCLUSIONS: The midterm angiographic results of CE with long arteriotomies and on-lay patch bypass grafting were better than the results obtained with the conventional pull-out method. This procedure was found to be safe and effective for complete revascularization in patients with a severely and diffusely diseased coronary artery.

Aged↗
PubMed1994

Vegetarianism, coronary disease risk factors and coronary heart disease.

Recent studies of vegetarians confirm a lower risk of fatal heart disease amongst such subjects. Lipid levels are lower in vegetarians, even when the diet of comparable meat-eaters is low in fat. This may partly explain the lower mortality, but it is not clear whether the absence of meat or some other aspect of the vegetarian diet is causal in this relationship.

Cohort Studies↗
PubMed1998

[Significance of calcium detection with electron-beam tomography in coronary disease].

PURPOSE: Coronary calcium is a powerful indicator of arteriosclerosis and can be detected very precisely with electron beam tomography. The method can be applied in patients with known coronary artery disease or in asymptomatic patients at risk of arteriosclerotic disease. METHODS: The standard protocol of EBT consists of 30 to 40 slices of 3-mm thickness with a scan time of 100 ms, no overlap. No contrast medium is needed. The total scan can be performed within one breathhold. The calcium score is calculated as described by Agatston. Radiation exposure amounts to 0.8 mSv per total screen. We used spiral CT with and without ECG trigger as an alternative. RESULTS: At the University of Munich we performed an EBT scan of the heart in 1100 patients within the last year. In 567 patients coronary angiography was performed also (+/- 3 days). Confirming previous reports in the literature, we found a correlation of the calcium score with the age and gender of the patients. Severe coronary artery disease (stenoses > or = 75%) was associated with significantly more calcium than less severe CAD. The calcium score did not discriminate between one-, two- and three-vessel disease. The site of calcification does not correlate with the localization of stenoses. Thirty-three percent of the patients with significant coronary artery disease showed a normal age-adjusted calcium score; a total of 8.1% of patients with severe stenoses did not reveal any coronary calcification (score = 0). With asymptomatic patients there are only a few studies available. Soft plaques cannot be detected with EBT, but in most patients soft plaques occur together with hard plaques. Our results show that spiral CT of the newest generation may also be used for calcium screening. There was an excellent correlation of the calcium scores of EBT and spiral CT at all levels of calcification. DISCUSSION: Coronary calcium is a sensitive marker of coronary artery disease. In the clinical setting EBT is indicated in patients with known coronary artery disease (to evaluate prognosis), in patients who are unable to perform a stress test, and in patients with atypical chest pain. However, lack of calcification may be associated with severe stenoses in a minority of patients. The clinical value in asymptomatic patients needs to be defined: randomized studies are necessary. We see a possible indication in patients with known risk factors, in whom primary preventive strategies could be performed more selectively and cost-effectively.

Adolescent↗
PubMed1978

[Hemodynamic and coronary effects of atrial stimulation in normal subject and patients with coronary disease: correlation with coronary arteriography].

Thirty-two patients (group I: 7 normal subjects; group II: 25 coronary subjects) underwent coronary arteriography, and measurements were made both in normal rhythm and under atrial stimulation of the pulmonary capillary pressure and the pressure in the femoral artery, of cardiac output, of coronary sinus flow (by continuous thermodilution), of the coronary arterio-venous oxygen difference, of oxygen consumption, and in 28 of the patients of the coefficient of extraction of K lactates. During stimulation, the only differences to appear between the subjects of group I and group II were an increase in capillary pressure (p less than 0.01) and a decrease in the coefficient of extraction of lactates (p less than 0.001) in the coronary patients. Similar differences were found between coronary patients with a stenosis greater than 70% in the anterior descending or circumflex artery (group IIa) and those without it (group 11b), and between the patients with pain during atrial stimulation (n = 9) and those without it. There was a good correlation between a double score (IVA + circumflex artery, Rowe's method) and the coefficient of extraction of lactates during atrial stimulation (n = 28, p less than 0.01).

Adult↗