[Sequential revascularization of anterior myocardium using the internal mammary artery. A year-long clinical and angiographic follow-up]. / Revascularisation séquentielle du territoire myocardique antérieur au moyen de l'artère mammaire interne. Suivi clinique et angiographique à 1 an.

One hundred and twenty-one consecutive patients (104 men, 17 women; mean age 56 +/- 7.8 years) underwent sequential mammary artery grafting for anterior (left anterior descending or diagonal arteries) wall revascularisation. There was one death (0.8%) and five myocardial infarctions (4.2%) including two anterior infarcts during the first 30 postoperative days. All survivors were reviewed at one year. Of these 120 patients, 77 (64%) accepted control coronary angiography on average 456 +/- 143 days after surgery. One internal mammary artery anastomosed to 2 diagonal arteries was occluded. All the other latero-lateral anastomoses were patent. There was, however, one 60% stenosis. Three termino-lateral anastomoses on the left anterior descending artery were occluded and 2 others stenosed (40% and 60% luminal narrowing, respectively). Four internal mammary arteries were narrowed 2 because of stenosis and 2 because of the small calibre of the receiving artery. The patency rate considering the total number of anastomoses was therefore 96.8%. These results show that sequential internal mammary artery grafting for myocardial revascularisation does not increase the number of perioperative complications and is associated with a low rate of occlusion on the left anterior descending artery at one year. This surgical technique may therefore be used routinely.

[Anterior interventricular revascularization using the internal mammary artery. Short and medium-term follow-up of 140 patients]. / Revascularisation de l'interventriculaire antérieure au moyen de l'artère mammaire interne. Suivi à court et moyen terme de 140 patients.

Between February 1983 and June 1987, 140 patients underwent surgery for anterior interventricular revascularization using the left internal mammary artery (the right had been used once). Operative mortality was 3.5%, but this value decreased to 2.2% when the familiarization period for the technique was taken into account. 112 patients were monitored for at least 11 months, and 85 of these accepted an angiographic examination at the end of the follow-up period. No graft was occluded. Only two were thin due to an inadequate stenosis of the anterior interventricular septum. One graft was 90% stenosed at its anastomosis. Moderate competitive flux was noted in five cases. These results are in agreement with published findings, and comparison with literature reports confirms that the internal mammary artery is superior to the saphenous vein as graft material.

[Coronary spasm during repeated anesthesia]. / Spasme coronarien lors d'anesthésies itératives.

Coronary arterial spasm observed during the course of two repeated anaesthesias in a patient having undergone aorto-femoral bypass grafting is reported by the authors. Such complications are accompanied by serious ventricular arrhythmias, though transient and healing without sequelae. Clinical and electrocardiographic characteristics of peroperative coronary arterial spasm are underlined. In patients prone to developing such spasm, peroperative alkalosis, hypothermia and parasympathetic stimuli should be avoided. Are emphasized the efficiency of preventive treatment with calcium antagonists and that of intravenous nitroglycerin in the treatment of peroperative coronary arterial spasm when it does occur.

[Evolution of myocardial temperature following cardioplegia with and without complementary pericardial cooling. Experimental study]. / Evolution des températures myocardiques après cardioplégie avec et sans refroidissement péricardique complémentaire. Etude expérimentale.

Myocardial temperatures were measured after cardioplegia during cardiac surgery with and without pericardial cooling by a cold bath. Eight animals (50 kg pigs) were placed on cardiopulmonary bypass using a protocol reproducing clinical operating conditions as closely as possible: myocardial mass, median sternotomy, general hypothermia at 25 degrees. Two injections of cardioplegic solution were administered, one at aortic clamping and the other, 30 minutes later. Four animals (Group A) were used as reference. The four animals in Group B underwent pericardial irrigation with serum at 4 degrees C. Myocardial temperatures were measured at 9 anatomical sites every 10 minutes, (a total of 1008 measurements) and compared statistically. The results in the control group showed that myocardial warming after cardioplegia was intense and rapid at all sites. The sub-epi and sub-endocardial temperatures rose from 7 to 24 degrees in 30 minutes, and in the first 10 minutes, a rewarming of 8,5 degrees was observed. When pericardial cooling was used with cardioplegia, myocardial refrigeration was improved. The temperature remained below 15 degrees C (p less than 0,05 compared with Group A). Only a 3 degrees rise in temperature was observed at the 10th minute after cardioplegia (p less than 0,001). The rise temperature was of 2 degrees at the 20th minute, and 1 degree at the 30th minute. All temperatures remained below 15 degrees C (p less than 0,01). The authors emphasise the benefits of pericardial irrigation associated with cardioplegia for constant, durable and stable myocardial protection by cooling.

[Thermal isolation of the heart by means of a plastic foam pad during surgical cooling of the heart: experimental study]. / Isolation thermique du coeur par patin de mousse plastique au cours de la réfrigération chirurgicale du coeur. Etude expérimentale.

Maintenance of myocardial cooling during aortic clamping is a problem encountered currently during heart surgery. A plastic foam isolation pad was studied. Eight animals (pigs weighing 50 kg) were placed on extracorporeal circulation, 4 of them constituting the control group (A). Two coronary injections of a cardioplegic solutions were administered, the first at the time of aortic clamping and the second 30 minutes later. The myocardium of the 4 animals in the treated group (B) was isolated with the foam pad, and this significantly prolonged the "cold" effect of the cardioplegic. Ten minutes after injection of the cardioplegic, temperature of the total myocardial mass with isolation was between 10.7 and 12 degrees C, as against 16 to 18 degrees C in the reference group (p less than 0.05). By the 20th minute, the isolated myocardium was at approximately 15 degrees C as against 22 degrees C in group A (p less than 0.01). Finally, by the 30th minute, temperature in group B was 17 degrees C as against 23 degrees C in group A (p less than 0.01). Reheating of the heart was significantly slowed by thermal isolation, though the limit of 15 degrees C was reached by the 20th minute. To ensure that myocardial temperature remains below this limit when the foam pad is employed, further injections of cardioplegic solutions are necessary every 20 minutes.

[Measurement of cardiac output by electrical impedance plethysmography during respiration and in apnea]. / Mesure du débit cardiaque par pléthysmographie électrique d'impédance au cours de la respiration et en apné.

The measurement of cardiac output by electrical impedance plethysmography (non-invasive technique) may be disturbed by a certain number of factors, including respiration. The authors sought to demonstrate that this factor could be eliminated during measurement calculations. By this method, in 18 adult subjects with coronary artery disease, 50 measurements during respiration and 50 measurements in apnoea (paired measurements) of stroke volume and of cardiac output were performed. Stroke volume was calculated using Kubicek's formula: SV = P(L2/Zo2) (dz/dt min)t Results were as follows: highly significant correlation between values for stroke volume obtained during respiration and in apnoea (r ;.9767; n=50; P < 0.001); highly significant correlation between values for cardiac output obtained under the same conditions (r = 0.9744; n=50; P < 0.001). The authors conclude that with the limits of certain technical conditions of measurement, respiration does not disturb measurements of stroke volume and of cardiac output by electrical impedance plethysmography.