Ventricular function before and after direct revascularization surgery. A proposal for an index of vascularization to correlate angiographic and ventriculographic findings

Abstract

In order to determine the effect of direct bypass surgery on the total coronary arterial supply to the heart, a numerical construct was devised to incorporate the development of new obstructive lesions and the presence of patent or nonpatent grafts. This construct, termed a vascularization index (VI), was used to evaluate left ventricular function and anginal symptoms after coronary artery bypass surgery in 56 patients. Patients with an increase in local or total arterial blood supply (positive delts VI) often had similar directional changes in segmental wall motion and ventricular ejection fraction. Patients with a decrease in local or total arterial blood supply (negative delta VI), due to either nonpatent grafts or progression of atherosclerotic disease, also usually had similar directional changes in segmental wall motion and ventricular ejection fraction. (Although nearly all patients reported a decrease in anginal symptoms after surgery, delta VI could not identify degree of improvement.) Use of an integrated approach in describing pre and postoperative myocardial blood supply appears to be the most reliable method of explaining changes in left ventricular function.