Circulation, Vol 55, 434-438, Copyright © 1977 by American Heart Association
RA Shaw, Y Kong, EL Pritchett, SG Warren, HN Oldham and GS Wagner
Ventriculograms made 9-15 months after surgery in 48 patients with normal
preoperative apical contraction were reviewed to determine the influence of
apical venting on apical wall motion in patients undergoing coronary bypass
surgery. After interpretation of postoperative apical wall motion, the
patients were subdivided into two groups. One group consisted of 34
patients who were vented by inserting a catheter through the apex of the
left ventricle and the second group included 14 patients in whom no
transventricular vent was made. The two groups were similar clinically and
hemodynamically before surgery, and the surgical procedures were similar
with the exception of vent site. Following surgery, incidences of graft
patency and antegrade flow to the apex were also similar. Nineteen (56%)
patients in the apically vented group had apical dyskinesia or akinesia
observed on the postoperative ventriculogram while none of the patients who
were not apically vented had these findings. None of the patients with
apical dyskinesia or akinesia had congestive heart failure following
surgery. The postoperative ventriculograms of 12 patients with mitral
stenosis who underwent valvulotomy by inserting a Tubbs dilator through the
apex were also analyzed. Only one patient (8.5%) had apical dyskinesia or
akinesia. Since the patients with mitral stenosis probably did not have
significant coronary artery disease, it is possible that the combination of
the apical vent and ischemic heart disease was responsible for the focal
contraction abnormalities observed.
ARTICLES
Ventricular apical vents and postoperative focal contraction abnormalities in patients undergoing coronary artery bypass surgery