SCREENING OF PATIENTS WITH ISCHEMIC-HEART-DISEASE BY TRANSESOPHAGEAL ATRIAL-PACING AND THE SELECTION OF SURGICAL THERAPY - IN PATIENTS WITHARTERIOSCLEROSIS OBLITERANS AND AORTIC-ANEURYSM

This study evaluated (1) a screening method for ischemic heart disease (IHD) using transesophageal atrial pacing (TEP), and (2) the appropri ate surgical therapy for patients with concomitant IHD which was evalu ated on the basis of the coronary score (CS) dy Leaman. Thirty-nine pa tients with arteriosclerosis obliterans of the lower extremities (ASO) and 35 with aortic aneurysm underwent TEP and coronary angiography (C AG). Coexistent IHD was diagnosed in 25 patients (64%) with ASO and in 14 (40%) with aortic aneurysm. Screening for IHD by TEP was 96% sensi tive, 71% specific, and 87% accurate in patients with ASO, and 79% sen sitive, 90% specific, and 86% accurate in patients with aortic aneurys m. Coronary artery bypass grafting (CABG) and peripheral arterial reva scularization (PAR) were performed by one stage surgery in 3 patients with a CS of 16 or more. In 18 patients with a CS of 5.5 or less, only PAR was performed. One stage surgery was performed in 6 patients with aortic aneurysm. Four patients had a CS of 9.5 or more, and 2 patient s with coexistent stenosis of the left anterior descending branch (LAD ) had CS of 3.5 and 8, respectively. Repair of the aneurysm was undert aken in 5 patients with a CS of 8 or less without LAD disease. In pati ents with ASO showing a CS of 5.5 or less and in those with aortic ane urysm showing a CS of 8 or less (and without LAD disease), the only su rgical procedure performed was either PAR or repair of the aneurysm. T here were no complications attributable to IHD observed in these patie nts during the perioperative period.