J.Jpn. Surg. Soc.. 60(2): 292-314, 1959
STUDIES ON THE SURGICAL TREATMENT OF CORONARY INSUFFICIENCY (ESPECIALLY ON INTERNAL MAMMARY ARTERY LIGATION)
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1st Surgical Department, Juntendo University School of Medicine (Director : Prof. Tamotsu FUKUDA) Seizo TAKENAGA |
1) With the use of plastic material injected specimens the coronary artery system was ,studied morphologically. The arborization of the septal branch was especially carefully studied and the presence of anastomosis with the coronary artery system was seen. The distribution of the coronary arteriole arborization within the myocardium was especially abundant in the middle layer.
2) By injection of dyes and contrast media the blood flow in the pericardiophrenic artery, the branch of the internal mammary artery, was shown to circulate in even normal conditions in all layers of the myocardium.
3) The blood flow of the pericardiophrenic artery enters the myocardium through the pericardial reflections by the way of the pericardium and anastomoses closely with the coronary artery system and is espcially richly distributed in the subendocardial layer.
4) The increase of coronary flow by 12.5% through internal mammary artery ligation was shown.
5) In experimental infarcts of dogs the mortality rate was remarkably reduced by internal mammary artery ligation. The ratio of the area of infarct with the controls did not show significant difference.
With results mentioned above it is believed that the mechanism of internal mammary artery ligation was elucidated.
6) Three cases of myocardial infarction and eight cases of coronary insufficiency was observed from 3 to 7 months after internal mammary artery ligation. Angina pectoris like symptoms, i.e., chest pains, tightness of the chest, palpitation, dizziness, dyspnea, etc. were relieved or abolished in all cases and ineffective results for anginal attacks were not seen.
7) The picture of coronary insufficiency on the E.K.G. showed a tendency to recovery in about a month after surgery but no change was seen in the infarction findings.
8) Of the 5 cases in which exercise load was compared before and after surgery the E.K.G. showed slight or no sign of coronary insufficiency. The distress of patients after exercise test was minimized to a large degree.
It can be said that exercise tests also clear indicate the effectiveness of this surgical procedure.
9) It can be said that internal mammary artery ligation is a widely useful procedure when compared to other surgical means because of its simple and safe methods employed.
It was also shown that the results of this operation can be classed as being fairly effective.
(author's abstract)
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