In 22 patients with ischaemic heart disease and conditions after infarction and angina pectoris a coronarographic examination was made as well as other auxiliary examinations incl. a complex analysis ...of the electrical cardiac field (KAESP) (23), using a Cardiac apparatus (manufacturer ZPA Cakovice). Using the KAESP method fibroses in the heart muscle were found in all 22 patients, while a classical electrocardiogram revealed them only in 12 patients (54.5%). Post-infarction fibrous changes on the inferior cardiac wall were detected by ECG in 10 patients, KAESP revealed this localization of changes in 17 patients. The difference was particularly marked as regards localization on the anterior cardiac wall, according to ECG it was in 2 patients, according to KAESP in 17 patients. The authors investigated also on isopotential repolarization maps focal changes caused by cardiac ischaemia associated with organic affection of the appropriate coronary artery as revealed by coronarography. Identical sites were proved in 18 patients by the two methods, i. e. in 81.8%. In the discussion the authors analyse the causes which influence the accuracy of assessment of the coronary artery in KAESP. In KAESP in addition to isopotential maps also other maps were used such as isointegral, iso-areal, asynchronic potential maxima and minima, isochronic maps, maps of negative isodivergencies, profile sections etc. (20).
To explore the surgical technique, anaesthesiological management, immediate and mid-term results, graft patency and effectiveness of less invasive coronary artery bypass grafting through a median ...sternotomy.
From January 1998 through December 1999, 144 patients had coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) done by one surgeon through a median sternotomy. The cohort of 107 men and 37 women averaged 60.8 years, mean ejection fraction (EF) was 51.8%. An average of 2.7 (range 1 to 5) grafts/patients was achieved. Results are compared with a CPB subgroup of patients operated on through a median sternotomy in the same time (N = 234). In a random subgroup of 100 patients (50 per group) an angiographic control of graft patency was done.
A non-CPB group showed less postoperative acute myocardial infarction (0.7% vs. 3.8%, p < 0.05) and atrial fibrillation (14.6% vs. 26%, p < 0.05), lower incidence of renal (2.8% vs. 5.1%, p < 0.05) and respiratory complications (2.0% vs. 3.8%, NS). We observed lower operative mortality (0.7% vs. 3.4%, p < 0.05), as well as the occurrence of low cardiac output syndrome (0.7% vs. 5.6%, p < 0.05) in the off-pump group. The follow-up is 36 +/- 12 months and the number of patients with recurrent angina, late AMI and late death is acceptable. We did not find an inordinate number of vein grafts occlusions (0.7% vs. 1.8%, NS) and stenoses (6.6% vs. 6.7%, NS) at anastomotic sites. None of the arterial grafts in both groups were occluded.
There was little known about the efficacy of the less invasive coronary artery bypass grafting at the beginning of our study. Starting with pioneering the operative technique, we have discovered and proposed three types of a heart verticalization and a reusable stabilizing device. We detected lower incidence of postoperative complications and decreased operative mortality in a non-CPB group. Angiographic assessment displayed an excellent run-off in both groups of patients. Off-pump coronary bypass grafting is associated with sufficient short-term graft patency and mid-term clinical outcomes.
The authors describe the clinical picture and results of some auxiliary examinations in 18 patients with the X syndrome, i.e. with angina pectoris with a normal angiographic finding on the coronary ...arteries. For the diagnosis of ischemic cardiac changes, which are an integral part of this syndrome, the authors used a complex analysis of the electric cardiac field by means of a Cardiac 128.1 apparatus (manufactured by ZPA-Cakovice). In patients with the X syndrome they observed a significant reduction of some potential and integral values, as compared with an equally sized group of healthy subjects. On maps of the electric manifestation of cardiac activity on the chest surface ischemic changes were revealed on the antrior and lower cardiac wall but also in its lateral and posterior wall. These changes were older and were found in the subendocardial layer or concurrently in another area of the heart with affection of the subepicardial layer. Minor non-transmural fibroses, most frequently on the septum, in some instances spreading to the anterior and lower cardiac wall, were a surprising finding. At present it is not possible to differentiate merely by analysis of the electric cardiac field the X syndrome and ischemic heart disease. This should be made possible by further comparative studies. The present paper is the first description of ischemic and fibrous cardiac changes in X syndrome diagnosed by a complex analysis of the electric cardiac field in the professional literature published in Czechoslovakia and other countries.
