Sakamoto T, Endo M, Nishida H, Tomizawa Y, Kihara S, Koyanagi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Oct;46(10):966-70. doi: 10.1007/BF03217856.
We evaluated the coronary artery bypass grafting (CABG) for the cases which were not amenable to preoperative left ventriculograms (LVG). Between June 1970 and March 1996, we had 2045 cases of isolated CABG, and 52 cases of which were not amenable to preoperative LVG. The reasons of no preoperative LVG were during cardiopulmonary resuscitation (CPR) in 4 cases, shock state in 14, NYHA class IV or CCS class IV in 26, angina attack after coronary angiography in 3 and so on. Preoperative diagnoses were acute myocardial infarction in 28, angina after infarction in 13, unstable angina in 9 and effort angina in 2. Preoperative conditions were reoperation in 6, insertion of intra-aortic balloon pumping in 46, chronic renal failure in 15 (hemodialysis in 4) and arrhythmia (VT or Vf) in 12. Concerning the coronary lesions, left main trunk and triple vessel diseases occupied 75% of all. Surgical deaths were 5 cases (9.6%) and hospital deaths were 4 cases (7.7%). The all cases which needed preoperative CPR were died with brain injury. The result of the cases which were not amenable to preoperative LVG were worse than the cases with ischemic cardiomyopathies. In conclusion, no preoperative LVG is one of the highest risk factors of all.
我们对术前无法进行左心室造影（LVG）的病例进行了冠状动脉旁路移植术（CABG）评估。1970年6月至1996年3月期间，我们共进行了2045例单纯CABG手术，其中52例术前无法进行LVG检查。无法进行术前LVG检查的原因包括：4例在心肺复苏（CPR）期间，14例处于休克状态，26例纽约心脏协会（NYHA）心功能IV级或加拿大心血管学会（CCS）心功能IV级，3例在冠状动脉造影后出现心绞痛发作等。术前诊断为急性心肌梗死28例，心肌梗死后心绞痛13例，不稳定型心绞痛9例，劳力性心绞痛2例。术前情况包括再次手术6例，主动脉内球囊反搏置入46例，慢性肾功能衰竭15例（4例接受血液透析），心律失常（室性心动过速或心室颤动）12例。关于冠状动脉病变，左主干和三支血管病变占所有病例的75%。手术死亡5例（9.6%），院内死亡4例（7.7%）。所有术前需要CPR的病例均死于脑损伤。术前无法进行LVG检查的病例结果比缺血性心肌病病例更差。总之，术前无法进行LVG检查是所有危险因素中风险最高的因素之一。
