Nagaoka H, Yano M, Tonouchi S, Iwata T, Nakahara H, Sakamoto T, Yamada T
Nihon Geka Gakkai Zasshi. 1985 May;86(5):613-8.
The effects of aorto-coronary bypass grafting (ACBG) on totally occluded coronary arteries (TOCA), postocclusion vessels of which were demonstrated angiographically through collaterals and left ventricular contractility were studied in eleven patients consisted of nine with transmural myocardial infarction (TMMI) on ECG in the area perfused by TOCA and without TMMI. Of eleven ACBG consisting of eight left anterior descending coronary arteries (LAD) and three right coronary arteries (RCA), all eight grafts to LAD were patent, whereas two of three to RCA were obstructed on the postoperative angiogram. The following evaluations were undertaken in the cases with patent grafts. In seven cases with TMMI (six LAD, one RCA), left ventricular ejection fraction (EF) increased from 0.56 +/- 0.08 (Mean +/- SD) to 0.65 +/- 0.07 (p less than 0.01). PLVSP/LVESV slightly increased, but not significantly. Mean Vcf increased from 1.07 +/- 0.33 to 1.83 +/- 0.88 circ/sec (p less than 0.02). Left ventricular segmental wall motion also improved from 23.1 +/- 6.8 to 29.5 +/- 7.2% (p less than 0.01), markedly in the anterior and apical segment. In two cases without TMMI, all of EF, PLVSP/LVESV, Mean Vcf and segmental wall motion improved much more than the cases with TMMI. In conclusion, it was suggested that ACBG to TOCA, especially LAD visualized angiographically through collaterals resulted in the excellent graft patency rate and the significant improvement of left ventricular contractility, even in the cases with TMMI.
对11例患者进行了研究，探讨主动脉冠状动脉搭桥术（ACBG）对完全闭塞冠状动脉（TOCA）的影响。这些患者的闭塞后血管通过侧支循环在血管造影中显示，并且研究了左心室收缩功能。11例患者中，9例在TOCA灌注区域的心电图显示有透壁性心肌梗死（TMMI），2例无TMMI。11例ACBG中，8例为左前降支冠状动脉（LAD），3例为右冠状动脉（RCA）。术后血管造影显示，8例LAD搭桥均通畅，而3例RCA搭桥中有2例阻塞。对搭桥通畅的病例进行了以下评估。7例有TMMI的患者（6例LAD，1例RCA），左心室射血分数（EF）从0.56±0.08（均值±标准差）增加到0.65±0.07（p<0.01）。左心室峰压/左心室舒张末期容积略有增加，但无显著意义。平均圆周纤维缩短率从1.07±0.33增加到1.83±0.88次/秒（p<0.02）。左心室节段性室壁运动也从23.1±6.8%改善到29.5±7.2%（p<0.01），在前壁和心尖节段改善明显。2例无TMMI的患者，EF、左心室峰压/左心室舒张末期容积、平均圆周纤维缩短率和节段性室壁运动的改善程度均远大于有TMMI的患者。总之，提示对TOCA进行ACBG，尤其是通过侧支循环在血管造影中显影的LAD，即使在有TMMI的病例中，也能获得优异的搭桥通畅率，并显著改善左心室收缩功能。
