Progress in Cardiology 6 [antikvár]

PREFACE This volume is dedicated to one of the most active and important of all current therapeutic problems: surgical treatment for coronary heart disease. Experts from Europe and North America discuss salient aspects of medical and surgical treatment and compare and contrast the two with special reference to their eflfect on prognosis. There is general agreement that stable angina can be substantially improved or relieved by coronary artery bypass grafting in at least 80 per cent of patients and that severe angina not responding to medical treatment is a firm indication for this procedure, provided that the pattern of coronary arterial disease is suitable and left ventricular function is adequate. Dr. Bristow in his chapter emphasizes these points and cites the supporting evidence of benefit afforded by myocardial oxygen consumption, coronary blood flow measurements and exercise stress testing. The efTect of operation on prognosis is not entirely certain except in significant obstruc- tion of the left main coronary artery, which is regarded as a definite indication for improved prognosis by Dr. Bristow, by Professor Julian and by Dr. Hultgren in their respective chapters. The general trend of the authors' view is that surgical treatment is valuable also for prognosis in severe three-vessel disease. The value of surgery in influencing prognosis in disease of two vessels remains uncertain, however, while general agreement inclines away from surgical benefit to prognosis in single-vessel disease. A concise policy for coronary arteriography and surgical treatment is outlined by Dr. Griflin and his colleagues in their chapter. The problems of unstable angina are discussed in detail. If the coronary arterial lesions are significant, early investigation and surgical treatment are recommended by Dr. Bristow. Dr. Conti gives a preliminary analysis of a prospective randomized trial and reports that, while there was no difTerence in mortality rates between patients treated medically or surgically, the incidence of