Some New Concepts of Coronary Heart Disease

In disease of the coronary arteries the myocardium is handicapped and endangered by ischemia; correction of this condition is the aim of the operation described here. With the patient under general anesthesia, the pericardium is opened. The parietal pericardium is abraded. A constricting ligature is usually placed about the coronary sinus, and before the end of the operation it is tightened to narrow the sinus to a diameter of 3 mm. Powdered asbestos is lightly sprinkled over the surface of the heart. The parietal pericardium is not closed, but the pericardial fat is sutured over the exposed surface of the heart. The mortality rate from this operation was found to depend entirely on how high a percentage of patients with advanced coronary disease were included in the series. In 110 patients with initially poor prognosis approaching the terminal stage, the hospital mortality was 11 %; among the remaining 234 patients, the hospital mortality was 3%. Subjective benefits from the operation included relief from pain and reduced intake of medicaments. Objective evidence of benefit included return to gainful occupation, rise in skin temperature of extremities, disappearance of arrhythmias, and increased force of heartbeat as recorded by ballistocardiogram. The lasting effects of the operation contrasted strongly with the temporary effects of medication.