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Objective: We sought to investigate the changes of velocity profiles in the left anterior descending coronary artery after coronary artery bypass grafting using transthoracic Doppler echocardiography., Methods: Forty-five patients who received a bypass graft to the left anterior descending coronary artery were studied. Before coronary artery bypass grafting, Doppler velocity profiles of the distal left anterior descending coronary artery were recorded with transthoracic Doppler echocardiography. Peak systolic velocity, mean systolic velocity, peak diastolic velocity, mean diastolic velocity, total velocity time integral, systolic velocity time integral, and diastolic velocity time integral were measured. Three weeks after coronary artery bypass grafting, left anterior descending coronary artery antegrade flow in the distal portion of the anastomosis was obtained by using the same method. Coronary angiography was performed before and 3 weeks after coronary artery bypass grafting., Results: The overall success rate of measuring the left anterior descending coronary artery flow was 60.0% preoperatively and 80.0% postoperatively. In 25 patients, in whom all parameters were obtained both before and after coronary artery bypass grafting, the following increased significantly after coronary artery bypass grafting: peak systolic velocity (14.86 +/- 7.50 vs 25.07 +/- 17.02 cm/s, P =.0045), mean systolic velocity (9.86 +/- 5.42 vs 18.03 +/- 12.94 cm/s, P =.0026), peak diastolic velocity (24.26 +/- 12.54 vs 48.28 +/- 31.66 cm/s, P =.0021), mean diastolic velocity (14.94 +/- 6.65 vs 30.36 +/- 20.71 cm/s, P =.0022), diastolic velocity time integral (7.22 +/- 2.88 vs 15.55 +/- 10.39 cm, P =.0009), total velocity time integral (10.50 +/- 4.48 vs 19.27 +/- 12.63 cm, P =.0034), and diastolic-to-systolic velocity time integral ratio (3.09 +/- 1.53 vs 4.97 +/- 2.75, P =.0044). Angiography showed graft patency and no significant change in left anterior descending coronary artery stenosis in all patients., Conclusions: Transthoracic Doppler echocardiography showed a significant increase in some parameters in left anterior descending coronary artery flow after coronary artery bypass grafting. Measurement of left anterior descending coronary artery flow by means of transthoracic Doppler echocardiography might be a noninvasive method to evaluate the effect of bypass grafting on the left anterior descending coronary artery.

Objectives: This study was designed to evaluate anastomotic sites located between the internal thoracic artery and left anterior descending coronary artery using transthoracic Doppler echocardiography, and then to clarify the accuracy of those results by comparison with coronary arteriographic findings., Methods: We examined 35 consecutive patients who had undergone bypass surgery. The echocardiographic examinations were performed within approximately 1 week of follow-up coronary arteriography, which occurred at 4.3 +/- 2.2 months after bypass surgery. We measured the diameter using intraluminal flow signals, and we also measured flow velocity., Results: Adequate spectral Doppler recordings of coronary flow in the anastomosis were obtained in 31 (89%) of the 35 study patients. In the normal anastomosis group (n = 25), the diameter and the peak blood flow velocity of the internal thoracic artery and left anterior descending coronary artery were 1.5 +/- 0.3 mm and 2.0 +/- 0.4 mm, and 58 +/- 25 cm/s and 47 +/- 20 cm/s, respectively. Stringed internal thoracic artery was found in 4 patients; the echocardiographic findings revealed a greater amount of information regarding the physiologic state in the area of anastomosis compared with angiographic findings. In a stenotic anastomosis found in 2 patients, the blood flow velocity findings at the anastomotic sites (83 +/- 228 cm/s) were higher than those in normal anastomotic patients (59 +/- 28 cm/s)., Conclusions: Transthoracic Doppler echocardiography enabled an effective evaluation of anastomotic sites between the internal thoracic artery and left anterior descending coronary artery in over 80% of our patients. This totally noninvasive method is thought to be reliable and able to provide a greater amount of information, compared with coronary arteriography, regarding the physiologic state of an anastomosis, such as a competitive relationship.

Background: We evaluated the efficacy of minimally invasive direct coronary artery bypass (MIDCAB) using the left internal thoracic artery (LITA) in patients with completely obstructed left anterior descending coronary artery (LAD)., Methods: Ten patients undergoing MIDCAB for LAD stenosis were enrolled in this study. These patients were all men aged 45 to 69 years, and were divided into two groups, one showing complete LAD obstruction (n=5, Group A), and one about 90% stenosis of the LAD (n=5, Group B)., Results: The internal size of the LAD at the anastomosis site was significantly smaller in Group A than in Group B, and the time required for graft anastomosis in Group A was significantly longer. Total operation time, intubation time after operation, perioperative bleeding, total blood transfusion, max CK-MB, and hospital stay did not significantly differ between the two groups. Postoperative coronary angiography revealed good graft patency in both groups, however, one Group A patient had graft obstruction., Conclusions: The MIDCAB procedure appears useful even in our patients with completely obstructed LAD, despite the long anastomosis time. However, the indications for this procedure are limited by any perceived difficulty in harvesting the LITA by indirect vision or in performing the anastomosis based on the size or quality of the LAD. Intensive preoperative angiography evaluation is essential and conversion to a median full-sternotomy is necessary for cases in which we cannot confirm the feasibility of MIDCAB.

We report a 69-year-old woman with lung cancer and severe stenosis in the left anterior descending coronary artery. To perform a curative operation for the lung cancer without myocardial infarction, minimally invasive direct coronary artery bypass and left lower lobectomy with video-endoscopic assistance were performed simultaneously. There was no major complication, and she was discharged at 14 days after the operation. This procedure may be useful and safe for patients with lung cancer and coronary artery disease.

A 86-year-patient who had acute myocardial infarction and critical cardiogenic shock was diagnosed to have the left main trunk (LMT) and triple vessel disease. Emergent coronary artery bypass grafting to the left anterior descending artery was performed using saphenous vein graft without cardiopulmonary bypass through median sternotomy. On the 41st postoperative day, catheter intervention was performed to the remaining lesions by stenting of LMT and percutaneous transluminal coronary angioplasty to the right coronary artery lesions. Tl scintigraphy showed remarkable reduction of myocardial ischemia. Hybrid therapy is the effective new strategy for critical cases which cannot be successfully and securely treated by medical or surgical approach alone.

Minimally invasive direct coronary artery bypass has the potential to cause an anastomotic failure because of a limited exposure of the operative field and the difficulty of internal thoracic artery harvesting. In the present study, the importance of preoperative marking for an accurate minithoracotomy location and a successful internal thoracic artery harvest was assessed. A paperclip was placed on the left nipple and a chest X-ray was performed in the supine position. By aligning the position of the paperclip to the location of the left anterior descending coronary artery from a coronary arteriogram frontal view, the intercostal space for the minithoracotomy was thus determined. Marking the incisional intercostal space during preoperative left internal thoracic arteriography revealed the number and location of the internal thoracic artery branches at the beginning of the harvest. This preoperative marking technique allowed for a more adequate exposure of the operative field and an easier internal thoracic artery harvest which therefore contributed to an improvement in the operative results.

Although minimally invasive direct coronary artery bypass (MIDCAB) eliminates the need for median sternotomy and cardiopulmonary bypass, its indications are limited. Conversely, coronary artery bypass without cardiopulmonary bypass (off-pump bypass) enables complete surgical revascularization under an optimal surgical field established by median sternotomy, even if patients have multivessel disease. The present study was designed to determine the invasiveness of median sternotomy by comparing 11 patients who underwent MIDCAB and 5 who underwent off-pump bypass between May 1997 and April 1998. There were no significant differences between the MIDCAB group and the off-pump group in age, being 57 +/- 11 vs 66 +/- 8 years old, the operative time, being 321 +/- 149 vs 441 +/- 205 min, the number of grafts, being 1.0 vs 1.4/patient, peak creatine kinase (CK) values, being 662 +/- 436 vs 609 +/- 56 IU/l, the peak CK-muscle-brain values, being 12 +/- 9 vs 16 +/- 5 IU/l, and the postoperative blood loss, being 369 +/- 198 vs 541 +/- 204 ml. Although there was no significant difference in peak C-reactive protein, at 17 +/- 5 vs 20 +/- 2 mg/dl, the periods declining within the normal ranges were shorter in the MIDCAB group than in the off-pump group, at 7 +/- 1 vs 15 +/- 2 days (P > 0.01). The hospital stay was almost the same in both groups, at 16 +/- 8 vs 26 +/- 14 days. These findings suggest that off-pump bypass is more invasive than MIDCAB, which may be attributed to the median sternotomy.

Objective: The recovery of cyclic variation (CV) of ultrasonic integrated backscatter (IB) may provide a more sensitive predictor of the success of myocardial revascularization. This study was designed to elucidate the possibility of real time assessment of coronary artery bypass grafting (CABG) using CV of IB., Methods: We studied 10 patients (61 +/- 4 years old) with the perfused areas by stenosed or occluded LAD without myocardial infarction. There were six ischemic dysfunctional areas, and four ischemic but non-dysfunctional areas. The CV of IB was measured before and just after extracorporeal circulation (ECC). Wall motion was analyzed by segmental wall thickening during systole at the same time of the IB analysis during CABG and at 3 weeks after CABG. Those 10 areas were completely revascularized., Results: In the non-dysfunctional areas, wall thickening did not change and remained at normal values before and after ECC, and 3 weeks after CABG (31 +/- 3% 29 +/- 3% and 29 +/- 5%, respectively). The magnitude of CV of IB did not also change before and after ECC (8.0 +/- 1.6 dB and 7.8 +/- 1.3 dB). However, in the ischemic dysfunctional areas, while wall thickening did not change before and after ECC (21 +/- 5% and 20 +/- 5%), it increased and reached similar values as the non-dysfunctional regions at 3 weeks after CABG (26 +/- 7%, P < 0.01 vs. before and after ECC values). The magnitude of CV of IB increased even after ECC (3.71 +/- 0.4 dB vs. 7.4 +/- 3.5 dB, P < 0.05), and reached the same level as those in the non-dysfunctional areas. There was a significant relationship between wall thickening at 3 weeks after bypass grafting and magnitude of CV of IB after ECC (r = 0.67, P < 0.05)., Conclusions: Improvement in wall motion was gradually attained after bypass grafting. On the contrary, an increase in the magnitude of CV of IB was obtained immediately after myocardial revascularization. Our data suggest that CV of ultrasonic IB method can provide close real time information regarding the effectiveness of bypass surgery.

Simultaneous minimally invasive direct coronary artery bypass and abdominal aortic aneurysm repair were conducted in a 66-year-old man uneventful, requiring no transfusion. Surgery required 9 hours and 2 minutes. The tracheal tube was extubated in the operating room. Postoperative bleeding was 215 ml. The postoperative course was very smooth, with the patient able to walk on postoperative day 1. Postoperative coronary arteriogram and aortogram showed favorable results and the patient was discharged on day 23 after surgery.

This study was designed to clarify the efficacy of coronary artery bypass grafting (CABG) on left ventricular (LV) function in 16 patients with a dilated LV due to myocardial infarction (LV end-systolic volume index: LVESVI >60 ml/m2). All had attained complete revascularization. To estimate the LV wall motion quantitatively using echocardiography, a wall motion score (WMS) was used (LV was divided into 17 segments with a four-point scale: akinesis=3, severe hypokinesis=2, hypokinesis=1, normal=0 and then summed). Exercise stress tests were performed after surgery, revealing that anginal symptoms had vanished in all the patients. In 5 patients with a preoperative end-systolic volume index (ESVI) >100 ml/m2, the ejection fraction (EF) did not change, and both were under 30% (before to after: 26+/-4 to 26+/-4%). Neither the ESVI (148+/-50 to 133+/-39 ml/m2) nor the end-diastolic volume index (end-diastolic volume index (EDVI): 198+/-62 to 180+/-37 ml/m2) changed; the WMS did not change (33+/-2 to 33+/-3). During exercise, in spite of the increase in heart rate (HR) (at rest, 81+/-20; HR during exercise, 111+/-21 beats/min, p<0.005) and LV end-diastolic pressure (EDP) (22+/-9; 35+/-13 mmHg, p<0.02), both cardiac index (CI) (2.4+/-0.3; 2.6+/-0.4 L/min x m2) and minute work (MW: 4.0+/-1.1; 4.1+/-0.4 kg x M/min) did not increase. In 11 patients with a preoperative ESVI <100 ml/m2, EF was extremely increased in 5 patients (more than 10%, 35+/-4 to 60+/-6%, p<0.005=improved subgroup) in whom the EDVI (130+/-16 to 120+/-13 ml/m2) did not change whereas the ESVI (82+/-14 to 48+/-7 ml/m2) was reduced. However, in the 6 remaining patients (ie nonimproved subgroup), neither ESVI (78+/-8 to 74+/-12 ml/m2), EDVI (115+/-10 to 115+/-20 ml/m2) nor EF (31+/-7 to 35+/-3%) changed. During exercise, HR (at rest, 88+/-13; during exercise, 108+/-11 beats/min, p<0.005), LVEDP (20+/-6; 29+/-7 mmHg, p<0.01), CI (2.5+/-0.6; 3.3+/-0.5 L/min x m2, p<0.05), MW (4.6+/-1.0; 6.5+/-1.5 kg x M/min, p<0.05) increased. The WMS in the nonimproved subgroup did not change (29+/-6 to 27+/-2), but in the improved subgroup it reduced after surgery (27+/-3 to 19+/-4, p<0.01). These data suggested that CABG in patients with a dilated LV was effective against anginal symptoms, but was restricted to left ventricular function. It may be possible to estimate postoperative LV function, including exercise tolerance, from the preoperative LVESVI.

Long-term results of coronary artery bypass grafting (CABG) in consecutive 32 patients with familial hypercholesterolemia, 6 homozygotes and 26 heterozygotes between 1976 and 1990, were analyzed. Seventeen patients in the early series underwent CABG with vein grafts alone. Subsequently, 15 patients underwent CABG with internal mammary artery grafting to the left anterior descending artery and received intensive lipid-lowering treatments early after CABG. All homozygotes and 1 heterozygote received intermittent low-density lipoprotein apheresis after CABG. There was only one late noncardiac death (3%), and the actuarial rates of freedom from cardiac events (myocardial infarction, cardiac death, and angina pectoris) were 60% at 5 and 10 years for homozygotes, and 87% and 73% for heterozygotes. The cardiac event-free curve for the heterozygous familial hypercholesterolemia group was comparable with that for the random age-matched subset of patients without familial hypercholesterolemia who underwent CABG during the same period. Two of 3 homozygotes and 4 of 14 heterozygotes in the early series had one or more cardiac events, whereas no patients in the late period had cardiac events. The patency rate of internal mammary artery grafts to the left anterior descending artery from 1 to 3 years after CABG was significantly higher than that of vein grafts to the left anterior descending artery (92 versus 45%; p < 0.05). Abdominal aortic aneurysm developed postoperatively in 2 homozygotes and 2 heterozygotes without sufficient cholesterol reduction. In conclusion, internal mammary artery grafting in combination with postoperative intensive lipid-lowering treatments, including low-density lipoprotein apheresis, may provide acceptably good long-term results of coronary revascularization in patients with FH.

Thirty patients with severe pump failure (Killip's degree III or more) complicating acute myocardial infarction (MI) underwent emergency coronary bypass grafting (CABG). Average age was 66 years old and CABG was performed 2.6 days after the onset of MI. The patients were divided into two groups according to the mechanisms that can bring about severe pump failure: 19 patients had large MI alone (G-I). The other 11 patients had severe ischemia occurring either at areas distant from the site of coronary occlusion or in the previous area at risk (G-II). To estimate the ventricular wall motion quantitatively, the left ventricular wall was divided into 17 segments. Each segment was graded on a four-point scale: akinesis, 3; severe hypokinesis, 2; hypokinesis, 1; normal 0. Wall motion score was estimated by summing the number of asynergic segments score. In G-I, Cardiac index (CI (l/min/m2)) increased from 2.03 +/- 0.91 to 2.68 +/- 0.73 and pulmonary wedge pressure (PCWP (mmHg)) decreased from 28 +/- 5 to 15 +/- 5, 72 hours after the surgery (p < 0.01). In G-II, CI increased from 2.17 +/- 0.78 to 3.17 +/- 1.01 and PCWP decreased from 29 +/- 6 to 13 +/- 5 after the surgery (p < 0.01). There was no difference in preoperative and postoperative hemodynamics between two groups. The wall motion score at the risk area did not change postoperatively (from 16 +/- 7 to 17 +/- 9 in G-I, from 15 +/- 8 to 11 +/- 5 in G-II).(ABSTRACT TRUNCATED AT 250 WORDS)

By using intraoperative myocardial contrast echocardiography, we assessed regional myocardial perfusion and transmural blood flow distribution immediately after myocardial revascularization. A total of 62 revascularized myocardial areas were studied in 31 patients undergoing coronary artery bypass grafting. The revascularized areas were divided into three different areas: S area, supplied by significantly stenosed coronary arteries (43 areas); C area, supplied by coronary collateral situation associated with totally occluded coronary arteries (12 areas); MI area, preexisting transmural myocardial infarction (7 areas). Myocardial contrast echocardiography was obtained by direct injection of 2 ml of sonicated 5% human albumin into the saphenous vein grafts at rest and during atrial pacing. Each area was divided into two layers of endocardial and epicardial halves, and myocardial enhancement of peak intensity was measured for each half and endocardial/epicardial gray level ratio was calculated: (1) The peak intensity of myocardial enhancement in S area and C area was significantly higher than that in MI area at rest as well as during pacing after myocardial revascularization. There was no significant difference in the peak intensity between S area and C area both at rest and during pacing. In S area the peak intensity significantly increased during pacing (p < 0.01), whereas it did not change in C area and MI area. (2) S area demonstrated no significant change in endocardial/epicardial intensity ratio during pacing. In contrast, the ratio in C area significantly decreased during pacing. (3) In S area with preoperative percent increase of segmental wall thickening lower than 25%, there was a significant correlation (r = 0.84, p < 0.001) between the peak intensity of myocardial enhancement and the postoperative changes of percent increase of segmental wall thickening in the revascularized areas. Thus, immediately after myocardial revascularization, intraoperative myocardial contrast echocardiography could provide a quantitative assessment of regional myocardial perfusion as well as blood flow distribution in the areas with myocardial infarction and with coronary collateral situation and in the areas supplied by stenosed coronary arteries.

We have assessed the long-term prognosis about cardiac death of isolated coronary artery bypass surgery from 1972 to 1988 in 361 consecutive patients. The duration of follow-up were from 0.4 years to 14.6 (mean 5.7) years. Of the 361 study patients, the operative morality was 4.7% (17 patients) and 29 patients (8.0%) died during follow-up, 11 (3.0%) of which were from cardiac causes. Actuarial survival rate was 85.2% at 10 years after surgery. The 10 year-survival rate was similar for patients with single, double, triple vessel disease, and left main trunk disease (94.5%, 83.7%, 75.1% and 89.1%, respectively). For patients with and without old myocardial infarction, the 10 year-survival rate was significantly different (75.4% and 93.3%, respectively) (p less than 0.005). In order to detect which factors of preoperative cardiac function among cardiac index, LV end-diastolic pressure, LV end-diastolic volume index, LV end-systolic volume index, and LV ejection fraction influenced the long-term prognosis, multivariant regression analysis was performed. Only LV end-systolic volume index was a significant factor, and the discriminative point was 50 ml/m2. For patients with LV end-systolic volume index less than 50 ml/m2 and greater than or equal to 50 ml/m2, the 10 year-survival rate was significantly different (88.3% and 32.9%, respectively) (p less than 0.005). In conclusion, the most significant factor influencing longterm prognosis after coronary artery bypass surgery was left ventricular end-systolic volume, indicating the importance of preventing preoperative dilatation of left ventricle.

We assessed the size and distribution of the native coronary artery selected for bypass grafting, using myocardial contrast echocardiography by injection of sonicated agents into a saphenous vein graft, during surgical revascularization. A total of 69 saphenous vein grafts (LAD, 16; D1, 10; OM, 13; PL, 13; RCA, 17) were performed in 36 patients with right dominant system at preoperative coronary angiogram. The size of the area of revascularized myocardium was quantified with the ratio of its circumference to a full circle depicted on the left ventricular short-axis view at the mid-papillary level. The extents of the revascularized area to LAD stenosing at the proximal portion was 28 +/- 6% and stenosing at the intermediate portion was 23 +/- 6%. D1, 10 +/- 2%; OM, 17 +/- 3%; PL, 22 +/- 6%, RCA, 17 +/- 5%. The extent of the areas perfused by the totally occluded coronary arteries with collateral vessels was similar to those perfused by the partially occluded coronary arteries. In conclusion, myocardial contrast echocardiography enabled the intraoperative assessment of the geometry of regional myocardial perfusion, and was very useful for the intraoperative evaluation of the effectiveness of the indicated surgical procedure.

We have assessed the long-term results of heptagenerians after isolated coronary artery bypass surgery from 1979 to 1989 in 32 patients over 70 (mean 72) years old using actuarial techniques. In these patients, the long-term results could not be properly assessed because many other factors other than cardiac events influenced their survival. Accordingly, we compared our subjects with the general population matching the operative age and sex characteristics from life tables (= matched population). There was no operative mortality. The 5 year and 9 year survival rates were 93% and 31%. In the matched population, the 5 year and 9 year survival rates were 81% and 59%. The survival rate between the two groups was not significantly different. We concluded that the long-term results of coronary artery bypass surgery in patients over 70 years were similar to those of the matched population. Therefore, coronary artery bypass surgery should be offered to older patients for usual indications.

We evaluated the late results of coronary bypass grafting (CABG) in 85 patients. The patients were divided into two groups according to preoperative MI size estimated by the Selvester QRS score; 24 with MI size of larger than 20% of LV muscle (group A; average 28 +/- 11%), and 61 with MI size smaller than 20% (group B; average 10 +/- 9%). New York Heart Association classes of both groups following CABG improved significantly (from 2.8 +/- 0.7 to 1.3 +/- 0.4 in group A; p less than 0.01, from 2.5 +/- 0.6 to 1.2 +/- 0.5 in group B; p less than 0.01). There was higher incidence of serious ventricular arrhythmias in group A than in group B (83% vs. 21%, p less than 0.01). In Group A, LVEF and LVESVI did not improve following CABG (from 17 +/- 9 to 16 +/- 8 mmHg, from 39 +/- 15 to 40 +/- 15%, from 66 +/- 28 to 69 +/- 40 ml/M2), while in Group B, those improved significantly (from 13 +/- 6 to 11 +/- 5 mmHg; p less than 0.01, from 53 +/- 14 to 58 +/- 10%; p less than 0.01, from 39 +/- 23 to 32 +/- 14 ml/M2; p less than 0.05). The exercise-to-rest LVSWI ratios increased significantly following CABG in both groups (from 86 +/- 25 to 160 +/- 56% in group A; p less than 0.05, from 92 +/- 31 to 140 +/- 37% in group B; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

This paper reports CABG which was successfully performed on a male patient of 70-year-old with severe chronic obstructive pulmonary disease (FEV1.0% 43%) and diabetes mellitus. The patient necessitated reintubation because of hypercapnea on 18 POD in spite of bronchodilator and physical therapies. Long respiratory care was continued after tracheotomy, and finally he could wean from the mechanical respiratory care utilizing acetazolamide (carbonic anhydrase inhibitor) on 59 POD.

We reported a 65-year-old male with the history of both cerebral and myocardial infarctions. Simultaneous carotid endarterectomy and myocardial revascularization (coronary artery bypass grafting = CABG) were performed. Ascending aorta was severely calcified. CABG was performed without aortic cross clamp under systemic moderate hypothermia and elective ventricular fibrillation. The wean off from extracorporeal circulation was successful. The postoperative course was uneventful. We recommend the simultaneous revascularization for the carotid and coronary artery obstructive diseases. CABG under ventricular fibrillation without aortic cross clamp was useful and unhazardous in patients presenting calcified ascending aorta.

Ischemic heart disease of elderly patients increased markedly and patients with high risk complications become to be candidates for CABG. Emergent CABG was undergone successfully on the high risk patient of 72 years with severe left ventricular dysfunction (EF 14%), old cerebral infarction, renal dysfunction, and Diabetes Mellitus. From this experience, CABG could be safely performed even in elderly patient with high risk, if the complications were avoided carefully. However, the long term problem may be the multifocal VPC due to left ventricular dysfunction including old myocardial infarction.

We evaluated operative results of emergency aortocoronary bypass grafting in 17 patients (surgical group) with impending myocardial infarction or acute myocardial infarction, and compared them to those of medical therapy in 16 patients (medical group) required IABP with same condition. Mortality in surgical group is significantly lower than that in medical group. In patients with severe coronary artery disease, mortality in surgical group is significantly lower than that in medical group. In patients with severe left ventricular dysfunction, mortality in surgical group is significantly lower than that in medical group. The period using IABP before the operation in expired patients is longer than that in survived patients. These data indicate that emergency operation should be performed immediately after IABP in patients with severe coronary artery disease or severe left ventricular dysfunction.

We investigated the measurement of blood flow of saphenous vein graft by Doppler Catheter. Under operation of femoro-popliteal bypass graftings (3 cases with 5 grafts of arteriosclerosis obliterans) with reversed saphenous vein grafts, blood flow of saphenous vein graft was measured. At the same time, blood flow of saphenous vein graft was measured by electromagnetic flowmeter. And the values obtained by Doppler Catheter (y) and those obtained by electromagnetic flowmeter (x) were compared. As a result, a good corelationship (y = 0.752 x -14.9, r = 0.836, p = 0, n = 20) was obtained. In conclusion, we suggest that the values of saphenous vein graft can be measured by Doppler Catheter. We actually measured the blood flow of saphenous vein graft with CABG. The measurement was thought to be possible.