Intraoperative Doppler-derived measurements of blood flow velocity were used to characterize the hemodynamics in 6 internal mammary artery grafts before and after anastomosis to the left anterior descending artery. Pulsed Doppler spectrum analysis demonstrated a change from a systolic to a predominantly diastolic flow pattern. The presented technique is a valuable aid to differentiate intraoperatively between normal and low flow states in the internal mammary artery. In addition, this study serve as a pilot study to investigate the clinical applicability of Doppler spectrum analysis in the functional assessment of the internal mammary artery in the pre- and postoperative stages of myocardial revascularization.

No abstract

Fifty-seven patients who had 72 thoracic sympathectomies have been reviewed. Twenty-five patients were preoperatively diagnosed as having primary Raynaud's phenomenon, 14 as having Raynaud's phenomenon secondary to arterial occlusion, 17 as having ischemia secondary to arterial occlusion and one as having hyperhidrosis. Twenty percent of the patients initially diagnosed as having primary Raynaud's phenomenon at the time of operation developed a collagenosis during the follow-up period. Improvement after 8 years' follow-up did not depend on the primary indication. Up to the fifth year after surgery a relapse was seen in cases of primary Raynaud's phenomenon. In secondary Raynaud's phenomenon a gradual decrease in improvement of 2% a year was seen during follow-up. In ischemia secondary to arterial occlusion, after 2 years the percentage of improved patients remained constant at a level of 70%. The mean improvement after 8 years follow-up according to the survival test of Gehan was 70 +/- 10%.

The effects of wrapping the internal mammary artery in Gore-Tex surgical membrane on the formation of adhesions were investigated. In seven goats both internal mammary arteries were dissected free from the thoracic wall. In six goats the internal mammary arteries were wrapped in Gore-Tex surgical membrane. In the remaining animal both arteries were removed and used as controls. After 6 months the goats were reoperated and it was found that the wrapped segments of all arteries were completely free of adhesions, whereas the non-wrapped segments showed severe adhesion formation. Histologic examination could not detect differences between the wrapped arteries and the controls. One of the 12 wrapped arteries was occluded by a longer existing thrombus, which is attributed to the surgical technique and the fact that postoperatively no anticoagulation was given. The beneficial effect of the use of Gore-Tex surgical membrane on the prevention of adhesion formation is excellent and this implies that it could be used in coronary artery bypass operations, thus reducing the chance of damage to the bypass in case of reoperation.

No abstract