Belov Iu V
Grud Serdechnososudistaia Khir. 1992(1-2):8-10.
The author systematized the indications for aortocoronary shunting in ischemic heart disease on the basis of complex evaluation of the patient's condition with obligatory consideration for the clinical picture of the disease, the condition of the coronary channel, and the left ventricular myocardium. An absolute indication for the operation is Functional Class II-IV angina pectoris with multiple affection of the coronary channel or stenosis of the trunk of the left coronary artery and maintained or moderately diminished function of the left ventricle. Radiologically-guided endovascular dilatation of the narrowing is first indicated for patients with stenosis of one or two coronary arteries. The main principle in operation in ischemic heart disease is attainment of complete revascularization of the myocardium by shunting all arteries measuring more than 1 mm in diameter which are stenosed by 50% and more. The main contraindications for the operation on the part of the heart are diffuse or distal affection of the coronary arteries, a more than two-fold reduction of ejection fraction as compared to the normal value, Stage IIB-III circulatory insufficiency.
作者在对患者病情进行综合评估的基础上，系统地整理了缺血性心脏病主动脉冠状动脉分流术的适应证，其中必须考虑疾病的临床表现、冠状动脉状况和左心室心肌情况。该手术的绝对适应证是功能性II-IV级心绞痛，伴有冠状动脉多处病变或左冠状动脉主干狭窄，且左心室功能维持或中度降低。对于一或两支冠状动脉狭窄的患者，首先考虑在放射学引导下对狭窄部位进行血管内扩张。缺血性心脏病手术的主要原则是通过对所有直径大于1毫米、狭窄50%及以上的动脉进行分流，实现心肌的完全血运重建。心脏方面手术的主要禁忌证是冠状动脉弥漫性或远端病变、射血分数较正常值降低两倍以上、IIB-III级循环功能不全。
