ABSTRACT
This paper describes the short-term results of surgical myocardial revascularization in 35 patients. Y configuration from one or two internal thoracic arteries was applied for bypass grafting of the left coronary artery. In 4 patients with truncal stenosis of the left coronary artery (LCA) or proximal stenoses of the anterior interventricular artery (AIVA) and circumflex artery, the length of the left internal thoracic artery (LITA) appeared adequate for creation of Y bypass and revascularization of the entire LCA pool. In most cases (28), Y bypass was formed from both ITA, which made it possible to revascularise more distant arteries of the posterolateral wall of the left ventricle. Analysis of bypass-graphies performed in 10 patients after 7 months on the average has demonstrated that occlusion (2) and stenosis of one of the branches (2) of Y bypass were most probably caused by underestimation of the degree of stenosis of the target coronary arteries.
Subject(s)
Coronary Stenosis/surgery , Internal Mammary-Coronary Artery Anastomosis/methods , Aged , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeSubject(s)
Captopril/therapeutic use , Heart Failure/drug therapy , Chronic Disease , Combined Modality Therapy , Diet, Sodium-Restricted , Drug Evaluation , Drug Therapy, Combination , Heart Failure/physiopathology , Hemodynamics/drug effects , Humans , Kidney/drug effects , Kidney/physiopathology , Rheumatic Heart Disease/drug therapy , Rheumatic Heart Disease/physiopathologyABSTRACT
The effect of captopril on renal function, central hemodynamics and the hormonal status was studied in 14 patients with chronic congestive heart failure in single administration of the drug at a dose of 25 mg and during short-term course therapy at a daily dose of 75 mg for 7 days. Captopril single administration was shown to cause an increase in natriuresis by 121% and diuresis by 120%. Correlation analysis showed that the natriuretic effect of captopril resulted from a decrease in tubular sodium reabsorption which, in its turn, was determined by a decrease in the production of angiotensin II and changes of pritubular circulation. Seven-day course therapy was accompanied by the patients' improved general status, improved indices of hemodynamics, and better tolerance to physical exercise. At the same time diuresis and renal excretion of sodium were above the basal level by 113 and 86%, respectively. It can be assumed that this natriuretic effect was determined by the suppression of angiotensin II, aldosterone and probably norepinephrine and vasopressin production. The analysis has shown that a favorable captopril renal effect is not mediated through improved central hemodynamics but results from changes of the hormonal and neurohumoral status.
