Shabalkin B V, Zhbanov I V, Abugov A M
Vestn Akad Med Nauk SSSR. 1990(10):6-10.
The causes of angina pectoris recurrences after aortocoronary bypass surgery have been studied. Indications for repeated myocardial revascularization and the possibilities for its performance have been analyzed. The long-term results of aortocoronary bypass surgery performed in 358 patients were evaluated at 30 months, on the average, after the operation. A gradual rise in the rate of angina recurrences was noted mostly within the first postoperative year. Repeated coronary angiography with bypass contrasting was done in 100 patients, 37 of whom presented angina recurrence. Impaired patency of the aortocoronary bypass was found to be the major cause of a recurrence (83.8%), this could be secondary to bypass thrombosis, fibrous hyperplasia of the graft intima, and atherosclerosis. Among other causes were incomplete revascularization of the myocardium and progression coronary atherosclerosis. All patients with pronounced angina pectoris were recommended repeated coronary angiography with bypass contrasting to specify indications for operation and possibilities for its performance. It was noted, that repeated revascularization may be hindered not by a factor responsible for the current recurrence, but primarily by the poor status of the distal portion of the diseased arteries due to diffuse atherosclerosis.
对主动脉冠状动脉搭桥术后心绞痛复发的原因进行了研究。分析了再次进行心肌血运重建的指征及其实施的可能性。对358例患者进行的主动脉冠状动脉搭桥手术的长期结果，平均在术后30个月进行了评估。术后第一年内心绞痛复发率大多呈逐渐上升趋势。对100例患者进行了带搭桥造影的重复冠状动脉造影，其中37例出现心绞痛复发。发现主动脉冠状动脉搭桥通畅性受损是复发的主要原因（83.8%），这可能继发于搭桥血栓形成、移植物内膜纤维增生和动脉粥样硬化。其他原因包括心肌血运重建不完全和冠状动脉粥样硬化进展。所有有明显心绞痛的患者均建议进行带搭桥造影的重复冠状动脉造影，以明确手术指征及其实施的可能性。值得注意的是，再次血运重建可能不是受导致当前复发的因素阻碍，而是主要受由于弥漫性动脉粥样硬化导致的病变动脉远端状况不佳的阻碍。
