CORONARY-ARTERY BYPASS SUPPLEMENTED BY GRAFTING OF THE RIGHT-VENTRICULAR BRANCHES - CASE-REPORTS

Seventeen patients presented with angina pectoris class IV with or wit hout dyspnea, or with dyspnea alone. Cardiac catheterization revealed an elevated right atrial mean (6.5+/-3.2 mmHg), right ventricular syst olic (31.3+/-10.3 mmHg) and diastolic (7.3+/-3.8 mmHg), pulmonary arte ry systolic (32.9+/-10.3 mmHg) and diastolic (15.4+/-5.8 mmHg), pulmon ary capillary wedge (15.2+/-4.8 mmHg), and left ventricular end-diasto lic (22.4+/-8.4 mmHg) pressures. The cardiac index was reduced (2.3+/- 0.6 L/min/m2), as was the left ventricular ejection fraction (39.6+/-8 .6%). Significant and diffuse coronary artery disease was present in 1 6 patients. In addition, their significant disease involved the proxim al acute marginal (n = 6), or the anterior ventricular (n = 5), or the anterior ventricular and acute marginal (n = 1), or the conus and ant erior ventricular (n = 1) branches of the right coronary artery. In th e remaining patients (n = 4), the latter artery had a significant lesi on above or below the origin of those branches, which were free of dis ease per se. The right ventricular branches provided intercoronary or intracoronary collaterals, or both, in 12 patients. Coronary artery by pass (4.6 grafts per patient) included vein grafts to the circumflex a rtery system (n = 22); the internal thoracic artery (n = 8), or vein ( n = 6), or both (n = 2) grafts to the left anterior descending artery; and vein grafts to the posterior descending artery (n = 8), diagonal branch (n = 7), ramus intermedius and right coronary artery (each, n = 3), and posterior left ventricular branch (n = 1). It was supplemente d by the vein grafts to the anterior ventricular (n = 9), the acute ma rginal (n = 7), or the acute marginal and conus (n = l) branches. One patient also had an aortic valve replacement. Hemodynamics after the o peration without pharmacologic support revealed significant decreases of the right atrial mean pressure to 4.7+/-2.5 mmHg (p < 0.01), pulmon ary artery systolic pressure to 24+/-7.0 mmHg (p < 0.01), pulmonary ar tery diastolic pressure to 11.9+/-3.4 mmHg (p < 0.01), and pulmonary c apillary wedge pressure to 9.6+/-2.9 (p < 0. 0 1). There was a highly significant decrease of the left ventricular end-diastolic pressure as measured indirectly by pulmonary artery diastolic pressure to 11.9+/- 3.4 mmHg (p < 0.001) and by pulmonary capillary wedge pressure to 9.6/-2.9 mmHg (p < 0.001). Cardiac index increased significantly to 3.2+/ -0.9 L/min/m2 (p < 0.01). All patients are alive and free of angina an d dyspnea. Did the revascularization of the right ventricular branches contribute to a functional improvement of the right and adjacent segm ents of the left ventricles and the septum?