Some New Concepts of Coronary Heart Disease

Fifty years of coronary artery bypass grafting

“…The development of coronary surgery can be traced back more than 100 years, when Alexis Carrel first described the concept of operating on the coronary circulation in 1910 and successfully performed intrathoracic aortic and cardiac anastomoses in dogs (4). In 1935, Claude Beck relieved his patients' angina pectoris by placing muscle pedicles, omentum, and pericardial fat inside the pericardium in order to increase myocardial blood supply (5). Arthur Vineberg further improved this concept in 1946 when he implanted the left internal thoracic artery (LITA) directly into the front wall of the left ventricle (6).…”

The Puzzle of Positive Results — Myocardial Revascularization

“…Beck speculated that venous congestion allowed the myocardium to extract more oxygen or minimized the oxygen differentials that produced fibrillating currents. 4 World War II put Beck's research on hold, but afterward he returned to myocardial revascularization and by 1955 had developed two distinct operations. 2 One involved placing a bypass graft between the aorta and the coronary sinus, arterializing the vein, and then partially ligating the distal sinus.…”

“…The other operation combined partial ligation of the coronary sinus with abrasion of the epicardium, application of asbestos powder, and grafting of mediastinal fat. 4,5 This procedure provided a modest increase in blood flow and, more important, ensured more uniform perfusion, reducing the risk of "selfelectrocution." 4 Results were gratifying.…”

“…4,5 This procedure provided a modest increase in blood flow and, more important, ensured more uniform perfusion, reducing the risk of "selfelectrocution." 4 Results were gratifying. Beck reported that 32% of 295 survivors studied were "completely or almost completely free of pain and have taken no medicaments since operation."…”

“…Another 62% had only occasional pain. 4 Patients who'd been incapacitated before surgery resumed their previous jobs or engaged in "some kind of gainful work." Eleven of 13 had significant improvement on ballistocardiography; 17 of 20 gained relief from "distressing and alarming" arrhythmias.…”