Ruptured atheromatous plaques in saphenous vein coronary artery bypass grafts: a mechanism of acute, thrombotic, late graft occlusion.

Although early occlusion of saphenous vein coronary artery bypass grafts is usually thrombotic, late occlusion is most often a result of progressive intimal fibromuscular proliferation or atheroma formation in the implanted vain. We describe another mechanism of late graft occlusion: atheromatous plaque rupture with superimposed occlusive thrombosis. Four men, ages 48-67 years underwent repeat bypass surgery for recurrent angina.

An appreciation of the new St. Jude valvular prosthesis.

Beginning in March, 1978, 88 patients have had cardiac valve replacements with St. Jude prostheses. There were 26 males and 62 females, aged 6 to 80 years (mean 60).

Improved angina threshold and coronary reserve following direct myocardial revascularization.

Angina threshold, coronary reserve, and global myocardial lactate metabolism were studied by atrial pacing in 18 patients with obstructive coronary artery disease before and after aortocoronary artery bypass (ACB) surgery. In 3 of these 18 patients, regional (anterior wall) metabolism was also studied. Following ACB, 16 of the 18 patients did not develop angina at the maximum pacing rate (MPR).

Surgical therapy in acute ischemic syndromes.

Despite increasing enthusiasm about the treatment of symptomatic angina pectoris by direct revascularization surgery, there appropriately continues to be concern about the effects of such therapy. While it is generally accepted that surgery is effective in relieving anginal pain in upwards of 80% of patients undergoing aortocoronary bypass, reservations focus on the possibilities that such therapy may increase the incidence of infarction (postoperative), accelerate the atherosclerotic process, and shorten longevity, primarily because of the increased early operative mortality. While these contentions may or may not be true for the majority of patients who undergo such therapy, there is accumulating experience that in certain well-defined subsets, surgery does favorably affect the prognosis of the disease.