J.Jpn. Surg. Soc.. 79(8): 848-854, 1978
Report on the annual meeting
CLINCAL EXPERIENCES IN THE SURGICAL TREATMENT (A-C BYPASS, MYOCARDIAL RESECTION) FOR CORONARY ARTERY DISEASE
|
2nd Department of Surgery, Kobe University School of Medicine Masayoshi Okada, Sakae Asada |
They were divided into operative techniques applied to angina pectoris and myocardial infarction and its complications. To date, we have operated on 25 cases of aortocoronary bypass (A-C bypass) and 1 case of aorto-coronary sinus bypass in the angina pectoris group.
The myocardial infarction group consisted of 16 cases as follows ; aneurysmectomy 2, scartectomy 5, myocardial infarctectomy 2, closure of postinfarction VSD 2, MVR for mitral regurgitation 3, and emergency A-C bypass 2 .
Five cases died of LOS postoperatively, and the remaining 19 cases are doing well without any complaints in the angina group. 5 cases out of 16 patients with myocardial infarction refractory to medical treatment survived by means of surgical intervention. The above described cases have helped us to determine as our procedures which are now being used surgical modus operandi for A-C bypass. They are as follows ; 1 . Anastomosis between the ascending aorta and saphenous vein should be performed under the beating heart to minimize the extracorporeal circulation time, 2 . The vent catheter should be inserted through the left auricle and the right pulmonary vein to decompress the left ventricle under the cardiopulmonary bypass. 3. The coronary artery is incised under electrically induced ventricular fibrillation. 4. Anastomosis between coronary artery and saphenous vein should be done after anoxic arrest and local cardiac cooling.
Some technical points we have found useful in myocardial resection such as ventricular aneurysmectomy, scartectomy and infarctectomy are as follows : 1 . Myocardial resection should be done under induced ventricular fibrillation, and the suture line should be reinforced with Teflon felt. 2. A-C bypass should be added to revascularize the remaining ischemic myocardium if indicated after myocardial resection.
To read the PDF file you will need Adobe Reader installed on your computer.