Jacques Saltiel

Clinical, angiographic, and hemodynamic findings in patients with anomalous origin of the coronary arteries.

Clinical and angiographic features of 31 patients with anomalous coronary artery origin are reviewed. Of 17 aberrant circumflex arteries from the right sinus of Valsalva or artery, each was retro-aortic, six atherosclerotic, and seven irrigated a small area of myocardium. Of seven anomalous right coronary arteries from the left sinus of Valsalva or artery, each was ante-aortic and two atherosclerotic. Aberrant origin of the circumflex or right coronary artery was a benign anomaly. The proximal course of seven aberrant left coronary arteries from the right sinus of Valsalva or right coronary artery was related to clinical events. The anomaly was best demonstrated in the lateral view. In five cases, coronary blood flow during exercise and myocardial metabolism during pacing were assessed. Two had had a previous infarction with nonatherosclerotic arteries. Exercise coronary blood flow was normal in four and low in one patient. Pacing resulted in lactate production in two with atherosclerotic and one without atherosclerotic arteries. We conclude that anomalous left coronary origin from the right sinus of Valsalva can result in significant myocardial ischemia and infarction.

Fate of Left Ventricular Contraction following Aortocoronary Venous Grafts: Early and Late Postoperative Modifications

Changes in left ventriclar contraction were studied approximately two weeks and one year after surgery in 87 patients having 131 venous grafts. Nineteen out of 37 or 51% of the ventricular wall motion defects revascularized by patent and intact grafts were improved following surgery. Hypokinesis was improved in 17 out of 24 instances (70%) and a normal contraction was restored in nearly half of the cases. Akinesis was improved in two out of 13 instances (15%). Following inadequate venous grafts, 15 out of 35 or 42% of the normal wall segments and four out of 16 or 25% of the hypokinetic wall segments were worse after surgery and late akinesis was frequent. Aortocoronary bypass surgery is followed by significant improvement as well as deterioration of left ventricular contraction and function. The late result of surgery is determined by the fate of aortocoronary venous grafts.

Aorta to coronary artery saphenous vein grafts. Preoperative angiographic criteria for successful surgery.

Abstract One hundred and fifty-four aorta to coronary artery saphenous vein grafts were assessed angiographically in 105 patients, approximately 2 weeks and, again, 1 year after operation. Twenty-one grafts were occluded at the early evaluation. After 1 year 30 additional grafts were occluded, and 6 grafts were severely narrowed. Late patency of vein grafts was related to coronary arterial runoff assessed by selective coronary arteriographie studies before operation. The diameter of the coronary vessel and the size of the distal vascular bed were important preoperative angiographie determinants of the fate of vein grafts. Distal coronary atherosclerosis Was also of consequence, but to a lesser degree. The presence of coronary arterial branches with a diameter smaller than 1.5 mm or vessels measuring 1.5 mm or more but perfusing a limited territory of cardiac muscle or having moderate to severe distal atherosclerosis was a poor indication for aorta to coronary bypass surgery. On the other hand, a low rate of early occlusion and a 75 to 80 percent late patency rate can be expected when grafts are anastomosed to coronary arteries with a diameter of at least 1.5 mm (preferably 2 mm or more) that perfuse a large peripheral vascular bed and are free of significant atherosclerosis. Comparison of diameter measurements of coronary arteries obtained at angiographic study and at operation showed an adequate correlation, thus confirming the validity of angiography as a satisfactory method in selection of candidates for aorta to coronary bypass grafts.

Angiographic Changes in Aortocoronary Vein Grafts: Lack of Progression Beyond the First Year

The angiographic aspect of aortocoronary vein grafts was reviewed three years after operation in 43 patients. These patients had been previously subjected to two selective angiographic studies: two weeks and one year after operation. The review of these angiographic studies suggests that the attrition rate of aortocoronary vein grafts levels off after the first year. Only three occlusions (5.4%) were found on the three-year study in the 55 grafts which were patent on the study conducted at one year. Two of the three occlusions occurred in grafts which had already displayed severe segmental reduction in size after one year. Moreover, the slight to moderate reduction in caliber noted in more than 70% of vein grafts between two weeks and one year after operation did not progress between one and three years. Thus, it appears that fibrous hyperplasia. which is believed responsible for these changes, is a time-limited process, and is not expected to progress after the first year.

Aberrant course of the left anterior descending coronary artery assoicated with anomalous left circumflex origin from the pulmonary artery.

We have presented a two year nonoperative follow-up of an asymptomatic 14-year-old girl with an unusual anomaly of the coronary arteries. Systolic and diastolic murmurs heard preoperatively did not change following severance of a patent ductus arteriosus. Postoperative selective coronary arteriography revealed (1) anomalous orgin of the left anterior descending artery from the right aortic sinus of Valsalva crossing between the aorta and pulmonary artery, (2) aberrant circumflex artery orgin from the pulmonary artery and (3) collaterals from the left anterior descending and right coronary arteries to the circumflex artery. This combination of coronary anomalies has never been described previously.

Improvement of left ventricular asynergy following aortocoronary bypass surgery related to preoperative electrocardiogram and vectorcardiogram

Abstract The preoperative ECGs and VCGs of 37 patients were studied to determine whether these techniques might help to forecast the outcome of left ventricular asynergy following aortocoronary saphenous vein graft surgery. It was found that akinesis was always associated with a pattern of old myocardial infarction and that it always remained unchanged after operation. Hypokinesis however was frequently improved. The incidence and degree of improvement were somewhat related to the presence or absence of old myocardial infarction. Hypokinesis without myocardial infarction improved slightly more frequently than that associated with a myocardial infarction (78.2 vs. 50 per cent). However, 65 per cent of the cases of hypokinesis without myocardial infarction returned to normal contraction following operation, whereas only 10 per cent of the cases with hypokinesis and myocardial infarction were completely improved. These findings suggest that the preoperative ECG and VCG may reasonably predict the outcome of hypokinesis following aortocoronary bypass surgery but only in terms of complete recovery, which is most frequently observed in hypokinesis without ECG evidence of old myocardial infarction.