Surgery of the ischemic heart disease in the rural area of Japan. Coronary artery bypass grafting to completely obstructed coronary artery / 日本農村医学会雑誌

ABSTRACT

The effects of coronary artery bypass grafting (CABG) to conpletely obstructed coronary arteries (COCA), with angiographically demonstrable collaterals distal to the occulusion, on the lef ventricular contractility and postoperative symptoms were studied in 18 patients consisted of 10 with transmural myocardial infarction (TMMI) on ECG in the area perfused by COCA and 8 without TMMI. Of 19 CABGs including 13 to left anterior descending coronary artery (LAD), 5 to right coronary artery (RCA), 1 to left circumflex coronary (LCX), all 13 grafts to LAD and 1 to LCX were patent, whereas 2 of 5 to RCA were obstructed on the postoperative angiogram. The following evaluations were undertaken in 16 patients with patent grafts. In 8 patients with TMMI, left ventricular ejection fraction increased from 0.56±0.08 (Mean±SD) preperatively to 0.65±0.07 postoperatively (p<0.005), left ventricular segmental wall motion improved from 21.6±6.7% to 29.6±6.5%(p<0.01). Angina disappeared postoperatively in all patients but one with TMMI. All patients showed clinical symptoms of NYHA class III or IV preoperatively, which were improved to be of class I or II postoperatively. In conclusion, it was found that CABG to COCA, especially to LAD was associated with an excellent graft patency rate and with significant improvement of left ventricular contractility, even in the patients with TMMI.