Bilateral internal mammary artery ligation for angina pectoris: Preliminary clinical considerations

Abstract

Since December of 1956, 82 patients have been operated upon. The criteria for ligation of the internal mammary artery in the second interspace, was the presence of angina pectoris. No other factor except this was used in selecting these cases. Fifty of the cases have been followed for two to six months. When the report is made up of this group of fifty, it can be noted that eighteen are asymptomatic, eleven are moderately improved, five are slightly improved, eleven are unchanged. Three of the patients died within one month of surgery, two patients died more than a month after surgery. In dividing the cases up into basic pathologic patterns, it was noted that those with hypertension as well as coronary disease seemed to do quite well. The hemodynamic types which accompanied valvular disease were also benefited, although these groups were not large and made up only ten of the fifty. Of the five patients who were operated upon within two weeks of an acute infarction, three are now dead. One death occurred in a patient with lymphoma; another death occurred in a patient who had pyelonephritis and developed uremia. It is pointed out that local anesthesia seems to be safer than even light general anesthesia for this procedure. It is also evident that evaluation of this surgical procedure will have to be based on a formula involving large numbers of patients and much time, leavened by careful follow-up studies.