Roskamm H, Weisswange A, Hahn C H, Jauch K W, Schmuziger M, Petersen J, Rentrop P, Schnellbacker K
Cardiology. 1977;62(3):247-60. doi: 10.1159/000169857.
In 222 patients with coronary heart disease hemodynamics at rest and during exercise were measured before and after aortocoronary bypass surgery. A total of 552 grafts were constructed, i.e. an average of 2.47 grafts per patient. Only 10.8% of the patients had a 1-vessel-disease, 59.2% had a 3-vessel-disease. 10.8% of the patients were provided with one graft, 49.7% got 3 or 4 grafts. In 92.8% of the patients the r. desc. ant. was significantly stenosed, and in 94.2% this vessel has been provided with a graft. Preoperatively only 7 patients had no angina pectoris during exercise (bicycle ergometer in supine position, each load lasting 6 min), postoperatively 154 patients have been completely free of angina pectoris. The preoperative angina pectoris-free exercise tolerance was 27.4 +/- 27.4 W (means +/- SD), postoperatively it was 76.5 +/- 33.8 W. The largest increase of exercise tolerance was observed in patients with a 3-vessel-disease (208%). Preoperatively only 10.1% had normal values of pulmonary wedge pressure and cardiac output at rest and during exercise, postooperatively 51.5%. The postoperative normalization of hemodynamics depends on the number of vessels involved (1-vessel-disease 86%, 3-vessel-disease 39.8% normalization) and on the status of the left ventricle (without a previous transmural myocardial infarction 68.4%; with a previous myocardial infarction 41.0%). The effects of revascularization on myocardial ischemia can be evaluated by measurements of pulmonary wedge pressure and cardiac output at rest and during exercise.
对222例冠心病患者在主动脉冠状动脉搭桥手术前后测量了静息和运动时的血流动力学。共构建了552条移植血管，即平均每位患者2.47条移植血管。仅10.8%的患者为单支血管病变，59.2%的患者为三支血管病变。10.8%的患者接受了1条移植血管，49.7%的患者接受了3条或4条移植血管。92.8%的患者右冠状动脉前降支严重狭窄，94.2%的该血管接受了移植血管。术前仅7例患者运动时无心绞痛（仰卧位自行车测力计，每次负荷持续6分钟），术后154例患者完全无心绞痛。术前无心绞痛的运动耐量为27.4±27.4瓦（均值±标准差），术后为76.5±33.8瓦。运动耐量增加最大的是三支血管病变患者（208%）。术前仅10.1%的患者静息和运动时肺楔压及心输出量值正常，术后为51.5%。术后血流动力学的正常化取决于受累血管的数量（单支血管病变为86%，三支血管病变为39.8%正常化）以及左心室状态（既往无透壁心肌梗死为68.4%；既往有心肌梗死为41.0%）。血运重建对心肌缺血的影响可通过静息和运动时肺楔压及心输出量的测量来评估。
