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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 54-year-old male with a left ventricular aneurysm and angina after myocardial infarction underwent Cooley's ventricular endoaneurysmorrhaphy with single coronary artery bypass grafting. On cardiopulmonary bypass, an elliptial Dacron felt patch was fashioned to replace the diseased area in the left ventricular cavity, restoring normal shape, contour and volume to the ventricule and stabilizing the still viable and functioning myocardium, and sutured to transition zone between viable myocardium and the fibrotic scarred area. At this time, single coronary bypass grafting (LITA to diagonal branch) was done. His post operative course was uneventful. The left ventricular systolic and diastolic function improved significantly in each variable measured on left ventriculogram analysis.
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PMID:[Ventricular endoaneurysmorrhaphy for the left ventricular aneurysm after myocardial infarction: technique and left ventricular function]. 811 91

Most cases of left ventricular aneurysms undergo operation through resection of the exteriorized dyskinetic area with longitudinal suturing of the opening and this technique has been considered by cardiologists (Froehlich et al) to bring no improvement to the morphology and performance of the left ventricle. Some technical modifications have been adopted, such as the septal plicature (Cooley) or circular suturing of the opening (Jatene). Since 1984 our team has used an endoventricular patch, sutured over the contractile area and excluding the akinetic non-resectable scars, bringing a significant and calculable improvement to the left ventricular function. This technique of left ventricular reconstruction (LVR), called endoventricular circular patch plasty (EVCPP) has been already used on more than 750 patients (May 97). Clinical and echographic data for each case are completed by right catheterisation with measurement of the cardiac output, pulmonary arterial pressures (PAP) and programmed ventricular stimulation (PVS), in order to detect eventual ventricular tachycardia (IVT). During left heart catheterisation, the morphology of the left ventricle (LV) is studied on right and left anterior oblique incidences and the LV ejection fraction (EF) is checked globally (GEF) and especially in its contractile portion (CEF). After surgery, a hemodynamic study associated with a PVS, is carried out during the first post-operative month, and again after one year. Results were clinically satisfactory in more than 90% of cases (8.9% of NYHA III-IV), and in more than 90% of cases with ventricular arrhythmia with the hemodynamic persistent EF at one year, superior to the pre-operative CEF. Thus we have to propose the following indications: Elective: This ventricular reconstruction can be recommended for ventricular aneurysms or akinesias with angina, arrhythmias or attacks of cardiac insufficiency, when GEF > 30% and CEF > 40%. The operative mortality rate varies from 1,5 to 3%, which is better than allowing natural evolution. Mandatory: In emergency, when safe immediate circulatory assistance or a cardiac transplant is unavailable, LVR can give hope for survival to more than 80% of patients, whereas natural evolution is without hope. Finally the operative indication is uncertain in two contrasting circumstances: In asymptomatic patients when hemodynamic and angiographic examinations after myocardial infarction show left ventricular dyskinesia. If GEF is below 40% and CEF below 50%, it seems wise to propose LVR in order to prevent unfavourable evolution. In end-stage ischemic cardiomyopathies, if the EF is below 20%, CEF is below 30%, cardiac output is below 1.5 l, and the mean pulmonary pressure is above 25, then a cardiac transplant should be considered. EVCPP with septal exclusion is a safe technique and easily reproduced when associated with coronary revascularization as far as practicable, then EVCPP improves the ventricular function. When associated with sub-total endocardectomy, then EVCPP allows excellent control of VA.
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PMID:Endoventricular patch plasties with septal exclusion for repair of ischemic left ventricle: technique, results and indications from a series of 781 cases. 965 17

Angina pectoris that is refractory to optimal medication and revascularization is becoming an increasingly common clinical problem. Recently the US Food and Drug Administration (FDA) approved transmyocardial laser revascularization (TMLR) for use in this group of patients and a large numbers of patients have already undergone this therapy. Unfortunately TMLR has is associated with an unacceptably high perioperative mortality (Cooley DA, Frazier OH, Kadipasaoglu KA, Lindenmeir MH, Pehlivanoglu S, KoIff JW, Wilansky S, Moore WH. Transmyocardiai laser revascularisation: clinical experience with twelve-month follow-up. J Thorac Cardiovasc Surg 1996;111:791-799; Horvath KA, Cohn LH, Cooley DA, Crew JR, Frazier GH, Griffith BP, Kadipasaoglu K, Lansing A, Mannting F, March R, Mirhoseini MR, Smith C. Transmyocardial laser revascularisation: results of a multi-centre transmyocardial laser revascularisation used as sole therapy for end-stage coronary artery disease. J Thorac Cardiovasc Surg 1997;113:645-654; Schofield PM, Sharples LD, Caine N, Burns S, Tait S, Wistow T, Buxton M, Wallwork J. Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trial. Lancet 1999;353:519-524), and recurrent refractory angina is common (Allen KB, Dowling RD, Fudge TL, Schoettle GP, Selinger SL, Gangahar OM, Angell WW, Petracek MR, Shaar CJ, O'Neill WW. Comparison of transmyocardial revascularization with medical therapy in patients with refractory angina. N Engl J Med 1999;341:1021-1028; Frazier OH, March RJ, Horvath KA, for the Transmyocardial Carbon Dioxide Laser Revascularization Study Group. Transmyocardial revascularization with a carbon dioxide laser in patients with end-stage coronary artery disease. N Engl J Med 1999;341:1021-1028). Temporary sympathectomy by stellate ganglion block (SGB) is in widespread use in a variety of chronic pain conditions and has long history of use in the management of angina (Moore DC. Stellate ganglion block. Springfield, IL: CC Thomas, 1954; Wiener L, Cox JW. Influence of stellate ganglion blockade on angina pectoris and the post exercise electrocardiogram. Am J Med Sci 1966;252:289-295). Here we describe a patient with end stage coronary artery disease and chronic refractory angina whose has been successfully treated with repeated unilateral left SGBs following multiple bypass operations, angioplasty procedures and laser therapy. This case report details his progress over a 34 month follow-up period.
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PMID:Long-term benefits of stellate ganglion block in severe chronic refractory angina. 1086 51

Myocardial infarction has been the major cause of mortality following operation for cerebrovascular insufficiency. In our institution, a clinical diagnosis of coronary artery disease was made in 37 of 125 (29.6%) consecutive male patients having carotid endarterectomy. Six of these 37 patients developed postoperative myocardial infarction. In contrast, none of the 88 patients without coronary artery disease developed myocardial infarction. A more recently treated group of 20 patients who had undergone carotid artery surgery and had previously undergone coronary artery bypass for angina did not develop postoperative myocardial infarction. These data suggest that in patients with both coronary artery and carotid artery disease, prior or concomitant coronary artery bypass should be considered. Myocardial infarction has been the leading cause of early and late death following operation for cerebrovascular insufficiency.(1) DeBakey(2) found operative mortality in patients having surgery for cerebrovascular insufficiency directly related to the incidence of coronary artery disease. An increased operative mortality due to reinfarction has been found in patients recovering from recent myocardial infarction.(3) Cooley(4) found that in patients having aortocoronary bypass there was no increased operative mortality 30 days after myocardial infarction and this may apply to patients having carotid endarterectomy. Subendocardial postoperative infarction associated with minor T wave changes and slight enzyme elevation had a better prognosis than did transmural infarction causing significant Q waves, sequential ST and T wave changes and marked enzyme elevations.(5) The purpose of this study was to document our experience with myocardial infarction in patients undergoing carotid artery operation for clinical coronary artery disease. Consideration of the role of saphenous vein bypass in those patients with coronary artery disease was the background for this review even though the evidence that myocardial infarction can be prevented with saphenous vein bypass operation is only preliminary at the present time.(6)
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PMID:MYOCARDIAL INFARCTION FOLLOWING CAROTID ENDARTERECTOMY. 1521 13

Postinfarction left ventricular aneurysm is a serious disorder that can lead to congestive heart failure, lethal ventricular arrhythmia, and premature death. Surgical treatment is indicated in established cases of congestive heart failure, angina pectoris, malignant ventricular arrhythmia, or recurrent embolization from the left ventricle. The goal of surgical intervention is to correct the size and geometry of the left ventricle, reduce wall tension and paradoxical movement, and improve systolic function. Surgical techniques for repair of left ventricular aneurysm have evolved over the last five decades. Aneurysmectomy and linear repair of the left ventricle was introduced by Cooley and colleagues in 1958 and remained the standard procedure until the late 1980s. Endoventricular patch plasty (EVPP) was then introduced as a more physiologic repair than the linear closure technique, especially when the aneurysm extends into the septum. However, there is still controversy whether EVPP is superior to simple linear resection in terms of impact on early and late clinical outcomes. In the current era of evidence-based medicine, the best strategy to resolve a controversy is through the explicit and conscientious assessment of current best evidence. This review article attempts to evaluate the current best available evidence on the impact of technique of left ventricular aneurysm repair on postoperative clinical outcomes.
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PMID:Impact of technique of left ventricular aneurysm repair on clinical outcomes: current best available evidence. 1943 91

A 53-year-old woman was referred to us for reoperation of aortic root. Twenty-three years ago, she was diagnosed with aortitis and suffered from annuloaortic ectasia, aortic regurgitation, severe stenosis of left carotid and subclavian arteries and occulusion of the main trunk of left coronary artery. The left coronary system was perfused by collateral arteries from right coronary artery. She had undergone original Bentall procedure( Cooley graft 26 mm+SJM valve 25 mm) with coronary artery bypass grafting (CABG)[saphenous vein graft (SVG)-left anterior descending artery (LAD)]. When she was 52 years old, she suffered from angina on efforts. Computed tomography and catheter angiocardiogram revealed pseudoaneurysm formation due to detachment of right coronary artery button and occulusion of SVG. We underwent redo aortic root replacement (Hemashield graft 26 mm+On-X valve 23 mm) with redo CABG (SVG-LAD). Eight mm graft was interposed between composite valve graft and right coronary button. Postoperative course was uneventful. She was discharged from the hospital on the 17th day, and is now doing well without any symptoms.
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PMID:[Aortitis Syndrome Requiring Redo Bentall Procedure with Coronary Artery Bypass Grafting due to Graft Detachment;Report of a Case]. 2903 8