Nitter-Hauge S, Frøysaker T, Hall K V, Enge I
Scand J Thorac Cardiovasc Surg. 1978;12(3):241-8.
To assess the haemodynamic effects of aorto-coronary saphenous vein bypass grafting, pre- and post-angiographic left ventricular end-diastolic pressure (LVEDP) and ejection fraction (EF) were measured before and in average 14 months after surgery in 80 patients. Symptomatic improvement occurred in 91% (73 of 80). In 43 patients with patent graft(s), pre-angiographic LVEDP and EF were unchanged (p always greater than 0.05), while postangiographic LVEDP was significantly reduced. Unchanged pre- and postangiographic LVEDP and EF were observed in 28 patients with double or triple grafts, with at least one graft patent and the other(s) occluded. Unchanged pre- and postangiographic LVEDP and reduced EF were observed in 9 patients with occluded single, double or triple grafts. We conclude that successful aorto-coronary saphenous vein bypass surgery in general does not improve resting left ventricular performance, but that the beneficial effect on left ventricular function can be demonstrated after a stress test such as ventriculography. A single graft to the left anterior descending artery seems to be of particular importance in this connection. On the other hand, deterioration was evident after unsuccessful surgery, particularly in patients with occlusions of 2 or 3 grafts. Digitalis therapy after operation or electrocardiographic indices of postoperative myocardial infarction apparently did not influence left ventricular performance.
为评估主动脉 - 冠状动脉大隐静脉旁路移植术的血流动力学效应，对80例患者在术前及术后平均14个月时测量了血管造影前后的左心室舒张末期压力（LVEDP）和射血分数（EF）。91%（80例中的73例）患者症状改善。在43例移植血管通畅的患者中，血管造影前LVEDP和EF无变化（p始终大于0.05），而血管造影后LVEDP显著降低。在28例有双支或三支移植血管、至少有一支移植血管通畅而其他血管闭塞的患者中，血管造影前后LVEDP和EF无变化。在9例单支、双支或三支移植血管闭塞的患者中，血管造影前后LVEDP无变化但EF降低。我们得出结论，一般而言，成功的主动脉 - 冠状动脉大隐静脉旁路手术并不能改善静息状态下的左心室功能，但在进行诸如心室造影等负荷试验后，对左心室功能的有益作用可以得到证明。在这方面，向左前降支动脉的单支移植血管似乎尤为重要。另一方面，手术不成功后左心室功能恶化明显，尤其是在有2支或3支移植血管闭塞的患者中。术后洋地黄治疗或术后心肌梗死的心电图指标显然并未影响左心室功能。
