Results of ten years aorto-coronary bypass surgery at the Thoraxcenter, Rotterdam

The aim of this thesis is the description of the outcome of isolated aortacoronary bypass operations, both regarding the short term effects i.e. the operative mortality as well as the Long term results i.e. the general wellbeing and survival probability of the patients over the years. The main indication for this type of surgery is and always has been, persisting angina pectoris despite extensive pharmacological therapy. The outcome of surgery therefore, should be judged, among other things, by the presence and severity of this syndrome in the post-operative period. To place these data in perspective, a review of the Literature on surgical therapy of angina is provided in chapter 2. As discussed in chapter 3, it has become apparent over the years that the perception of the severity of angina pectoris is changeable and very difficult to quantify. Still an attempt has been made, to analyse the data on this complaint, although it is realised that it is fraught with errors as simplifications are required when Large numbers are to be judged. Improved survival has by now become an important issue to justify bypass surgery. A multivariate analysis of the factors which influence survival is provided in chapter 4. For comparison, the survival probability of the general population in the Netherlands, matched for age and sex, has been related to the data of the patients under study. In chapter 5 the evolution in po

Left ventricular performance during coronary angioplasty

Left ventricular (LV) performance during elective single vessel coronary angioplasty (PTCA) was assessed in 67 patients with intravenous digital subtraction ventriculography. Left ventriculography, following right atrial contrast injection, was well tolerated and produced images suitable for analysis in all cases. During balloon inflation, marked contractile abnormalities developed rapidly in ventricular segments subtended by the treated artery. The degree of contractile dysfunction was lessened in the presence of collateral vessels and was independent of short (20 secs) or long (60 secs) balloon inflation, and the presence or absence of additional coronary disease. During PTCA LV end-diastolic volume remained unchanged and LV end-systolic volume increased. However, ECG R wave amplitude decreased, supporting the view that during ischaemia LV volumes are independent of R wave amplitude. "Reciprocal" ECG changes were examined in patients with single vessel disease undergoing left anterior descending PTCA. Despite the development of inferior ST segment depression, inferior LV segmental contraction remained unaltered while inferobasal contraction was augmented. This confirms that these remote ECG changes did not indicate additional ischaemia but represented only an electrical phenomenon. In patients undergoing PTCA after successful thrombolysis for acute myocardial infarction, balloon occlusion was used to "reproduce" thrombotic coronary occlusion. A deterioration was apparent in global and regional LV performance during balloon inflation which may represent the extent of myocardium salvaged by thrombolytic therapy. In the 37 patients studied after PTCA, segmental contraction had returned to baseline values confirming that multiple balloon coronary occlusions of up to 60 seconds do not produce sustained abnormalities of LV contraction detectable by this method. PTCA allows a unique opportunity to examine the immediate effects of controlled coronary occlusion on LV performance. Intravenous digital subtraction ventriculography provides a valuable method with which to study these changes