Left Ventricular Performance Following Direct Myocardial Revascularization

FEW DATA are presently available concerning the long-term influence of direct myocardial revascularization on left ventricular performance. This subject is of great practical importance. First of all, in the experience of many centers, moderate to severe left ventricular dysfunction carries a significant risk of increased early and late postoperative mortality. Secondly, due to the placebo effect of any intervention on angina, evaluation of the results of bypass operations based on subjective data alone is unreliable. Moreover, improvement in the functional state of the myocardium might be an important objective to be sought following aortocoronary revascularization. Regional abnormalities of left ventricular contraction are frequent and can be detected, at cineventriculography, in about 609 of patients with coronary artery disease. These abnormalities correspond, with few exceptions, to significant proximal obstructions of the coronary arteries. The direct relationship of these contraction defects to myocardial fibrosis and ischemia has been stressed.' In several instances, the heart muscle may be structurally normal but partly inactivated because of ischemia. In a recent issue of Circulation, Chatterjee et al.2 have described marked improvement two weeks