Left ventricular hemodynamics and contractile patterns were evaluated in 104 patients before and after aortocoronary bypass surgery. Patients were selected on the basis of referral for surgery because of angina pectoris and the demonstration, postoperatively, of all grafts being patent. Group I consisted of 47 patients with single grafts (LAD 33 and RCA 14). Mean left ventricular end-diastolic pressure, volume, and ejection fraction revealed no change after surgery. Twenty-four patients had asynergy prior to surgery; of these 24, 16 patients had a normal contractile pattern after surgery. Group II consisted of 47 patients with double vein grafts. Postoperatively, there was a significant decrease in left ventricular end-diastolic pressure (p < 0.005) and increase in ejection fraction (p < 0.001). Asynergy in 29 patients preoperatively revealed synergy after surgery in 15 patients. Group III consisted of ten patients with triple vein grafts. Ejection fraction increased postoperatively (p < 0.01). All but two of the eight patients with asynergy preoperatively showed synergy after surgery. In the entire group of patients, 43 with synergy preoperatively, with but one exception, had synergy after surgery. Asynergesis in 41 instances preoperatively revealed postoperatively that 38 patients (93 per cent) had normal wall movement. In 29 instances of preoperative akinesia of one wall, only 8 patients (28 per cent) showed a return to normal wall movement. Unstable angina pectoris alone did not influence reversibility of abnormal contractile patterns. Unstable angina pectoris with absence of abnormal Q-waves in the ECG was noted in 23 patients with asynergy; all but one of these patients had a normal contractile pattern after surgery. Patients with infarction pattern on the ECG, when accompanied by asynergy, were unlikely to have a normal contractile pattern after surgery (4 out of 23 patients). Reversibility of left ventricular function after surgery is common, not related to number of grafts, but is related to type of wall abnormality noted prior to surgery as well as the ECG and clinical state of the patient.
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