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Biomedical subjects

G M FitzGibbon

Publications and source records attributed to G M FitzGibbon.

At least 19 recordsLinked to original sources
PubMed1991

Coronary bypass graft fate: long-term angiographic study.

In 222 patients, 741 venous coronary bypass grafts were studied angiographically early, at 1 year and at a late examination at greater than 6.5 years (mean 9.6) after operation; 565 of these grafts were also examined 5 years postoperatively. Grafts were graded for patency and disease considered to be atherosclerotic and for both extent and profile of lesions. Graft occlusion rates increased steadily from 8% early to 20% at 5, 41% at 10 and 45% at greater than 11.5 years after operation. All grafts were considered free of atherosclerosis early, but disease appeared in 8% at 1 year, increasing to 38% at 5 and 75% at 10 years postoperatively. Increasing involvement of vessel wall area was associated with greater protrusion of lesions into the graft lumen. Diseased grafts became more so at subsequent examinations, with occlusion occurring in many. However, absence of disease had little prognostic significance because diseased and abruptly occluded grafts were generated in those with healthy appearance at earlier examinations. For instance, 82% of very diseased grafts at the 5 year study originated from normal grafts at 1 year and 73% of occluded grafts at 1 year had appeared normal early postoperatively. Of 590 patent grafts free of disease at 1 year, 30% were occluded at the late examination, 76% of those patent were diseased, 55% of these were diffusely diseased and 35% were greater than 50% narrowed. Only 17% of the original 590 patent grafts were healthy at this time. Bypass graft atherosclerosis severely limits the long-term utility of these grafts. It is suggested that the solution may lie in some powerful drug regimen.

Adult↗
PubMed1987

Atherosclerosis of coronary artery bypass grafts and smoking.

Follow-up angiography was performed at selected intervals on 340 men who had undergone coronary artery bypass surgery. There were 1160 grafts, but 112 were excluded from study because they occluded shortly after the operation. After 5 years 115 patients were smokers and 225 were nonsmokers. The mean number of grafts per patient was similar in the two groups. We classified each graft according to irregularities in graft outlines and graft patency and found disease-free grafts in 39% of the smokers and 52% of the nonsmokers; the proportion of diseased or occluded grafts was greater in the smokers than in the nonsmokers. Our results do not identify the effect of smoking cessation after bypass surgery, but they do suggest that men who continue to smoke are at significantly greater risk of atherosclerosis and occlusion than nonsmoking men.

Angiography↗
PubMed1987

Atheroembolic perioperative infarction during repeat coronary bypass surgery: angiographic documentation in a survivor.

We report the case of a patient in whom a myocardial infarction complicated a coronary bypass reoperation. We believe the infarction was associated with embolic occlusion of a large coronary branch by atheroma, which we demonstrated in a previous bypass graft preoperatively and did not see in the postoperative study. We are not aware that atheroembolism of a large coronary branch has been reported before in a survivor of reoperation.

Adult↗
PubMed1987

Coronary artery disease and coronary bypass grafting in young men: experience with 138 subjects 39 years of age and younger.

One hundred thirty-eight men aged less than or equal to 39 years had coronary bypass grafting during a 13 year period. Angina was the presenting symptom in 77% and of these patients, one-third had unstable angina. More than half of the patients had experienced at least one myocardial infarct. There was a high incidence of coronary risk factors, especially smoking. Nineteen patients (13.8%) had left main coronary artery stenosis (it was isolated in two); 13.8, 24.6 and 60.2% had single, double and triple vessel disease, respectively. Left ventriculograms showed serious functional impairment in 42%. A total of 461 coronary bypass grafts, 3.34 per patient, were placed; almost all were vein grafts. There were no operative deaths. Transmural myocardial infarction occurred in 4.3% of patients. All bypass grafts were opacified angiographically early after operation, 95% at 1 year, 56% at 5 years and 26% at 10 years after operation. Some patients also had coronary angiograms, dictated by clinical events, between 1 and 5 and between 5 and 10 years postoperatively. Patency rates for bypass grafts were comparable with those previously reported and were acceptable, although they decreased with time. However, increasing evidence of atherosclerosis of bypass grafts was seen beyond 1 year, particularly beyond 5 years. Of 23 subjects with a coronary bypass reoperation, 2 died and 44% had perioperative transmural myocardial infarction. During follow-up, 13.8% of the patients died, survival being 95, 84 and 76% at 5, 10 and 12 years, respectively. It is considered that the patients were advantageously treated with coronary bypass grafting especially in the short-term. However, bypass graft patency steadily decreased with the passage of time and graft atherosclerosis became an increasingly important problem.

Adult↗
PubMed1986

Sequential coronary bypass grafts. Long-term follow-up.

Sequential venous coronary bypass grafts have presented problems, mainly because of commonly reported differences between patency of side-to-side and end-to-side vein-coronary anastomoses. Better to define this, we have studied sequential anastomosis grafts done during a 13 year period. We concentrated specifically on 212 "double" grafts with 100% selective angiographic follow-up early, 90% at 1-year, and 44% at 5 years after operation. Four hundred twenty-four control single grafts were studied similarly. We found that patency rates of side-to-side anastomoses were much better than those of end-to-side anastomoses, whether of sequential or control single grafts. Considering specifically diagonal coronary artery-anterior descending coronary artery sequential grafts, the combined patency of all sequential anastomoses theoretically exceeds that of a comparable number of single grafts at all times of study, but the differences are small. Furthermore, there is definite danger of preserving proximal and perhaps limited bypass runoff at the cost of losing distal and perhaps more important myocardial perfusion. On balance, we believe that single vein grafts are to be preferred over sequential grafts unless shortage of conduit material or local aortic wall conditions dictate otherwise.

Coronary Angiography↗
PubMed1986

Coronary bypass graft fate. Angiographic study of 1,179 vein grafts early, one year, and five years after operation.

A total of 1,179 vein grafts were studied angiographically in 353 (45%) unselected survivors (male, mean age 45.5 years) of 786 coronary bypass operations. Studies were conducted early (0.96 months), 1 year (12.8 months), and 5 years (59.7 months) postoperatively. A previously described technique was used to grade the patency of the grafts, and a new technique was used to assess intimal irregularity, presumably caused by atherosclerosis; this new technique indicated both intimal surface distribution of disease and profile (relief or elevation). Ten percent, 17%, and 26% of grafts were occluded early, at 1 year, and at 5 years, respectively. Distal anastomotic defects were the commonest cause for low grades in the patency classification. Irregularities in patent grafts increased from 9% at 1 year to 42% at 5 years, with 11% of all the 1 year lesions and 20% of all the 5 year lesions having a high profile (more than 50% graft stenosis); of the lesions categorized as showing the widest surface spread, 17% were in high relief at 1 year and 34% at 5 years. Thus, the lesions we believed to be atherosclerotic proliferated in both surface spread and elevation. All severely diseased grafts at the 1 year study had been normal in outline early; 79% at the 5 year study had been disease free at 1 year. All newly occluded grafts at the 1 year study had been normal in outline and 82% had had good patency early; 78% of newly occluded grafts at the 5 year study had been disease free at 1 year and 77% had had good patency. Normal appearance of the intima in grafts studied at 1 year had no prognostic value for 5 year findings. However, 62% of all grafts with the appearance of intimal disease at 1 year showed deterioration by 5 years, and 28% were occluded. The differences between these outcomes are highly significant (p less than 0.0005). In conclusion, the appearance of intimal irregularity compatible with atherosclerosis in a coronary bypass graft 1 year after operation carried a poor prognosis for adverse angiographic change at 5 years. On the other hand, normally appearing intima at 1 year had no predictive valve for the 5 year study despite a generally better prognosis for nondiseased grafts.

Adult↗
PubMed1984

Aorta-coronary bypass in patients with coronary artery disease who do not have angina.

During an 8 year period we performed coronary bypass operations in 118 consecutive patients who were not experiencing angina when selected for surgical treatment. Their mean age was 45 years, collectively they had had 87 myocardial infarcts, and 42% had at least moderately abnormal ventriculograms. Considering 50% coronary stenosis "significant," 9% had single-, 23% double-, and 68% triple-vessel disease; 15% had left main coronary artery disease also. Operations, which involved placing a mean of 3.6 grafts per patient, included 39 endarterectomies and 11 ventricular aneurysm repairs. There were no operative deaths, but eight (6.8%) died during a mean 6.7 year follow-up. A retrospective comparison was made between these 118 patients and a consecutive series of 605 others, mean age 46 years, having angina and also treated surgically during the same period. Five (0.83%) of these latter patients died perioperatively and 42 (6.9%) during a mean follow-up of 6.4 years. The no-angina patients had significantly more prior myocardial infarcts and more abnormal ventriculograms; the angina group had a significantly higher reoperation rate. However, there were no significant differences between the two groups in age, coronary disease severity, results of treadmill testing, number of grafted vessels, endarterectomies, ventricular aneurysm repairs, perioperative infarcts, operative or late mortality, or early, 1 year, and 5 year graft patency rates. We have concluded that, with the exception of cardiac ischemia warning, our patients without angina, treated surgically, were similar in most important respects to patients in a concurrent series in which angina was one of the indications for operation. We believe that coronary bypass is safe for such individuals without angina and probably as as effective as for those with cardiac pain.

Adult↗
PubMed1981

Perioperative myocardial infarction complicating coronary bypass. Clinical and angiographic correlations and prognosis.

To investigate the importance and the causes of myocardial infarction complicating the coronary bypass operation, we have reviewed clinical and preoperative angiographic data on 717 patients operated on over an 81/2 year period and postoperative angiography on all but one survivor. The hospital mortality was 0.6%. Of the 56 (7.8%) patients who sustained perioperative myocardial infarction, two died. Left ventricular angiography supported the diagnosis in 40 patients and aided in quantification of myocardial infarction. Age, preoperative symptomatic status, incidence of prior myocardial infarction, and perfusion and axoxia timed did not correlate with myocardial infarction, but extent of coronary disease, number of grafts, and associated endarterectomy did. There have been no late deaths in the 54 survivors of perioperative infarction, which appears usually to be a benign event. Graft occlusion was nearly three times commoner in patients with myocardial infarction, and in 42 of 54 survivors the myocardial infarction could be explained by new impairment of perfusion, usually owing to compromise of the grafted artery. The relationship of perioperative infarction to iatrogenic diminution of perfusion, of the infarcted segment suggests that technical factors, especially meticulous attention to the quality of the graft-coronary artery anastomosis might further reduce the perioperative infarction rate.

Coronary Angiography↗
PubMed1978

Coronary bypass graft fate: angiographic grading of 1400 consecutive grafts early after operation and of 1132 after one year.

All 1400 coronary bypass grafts, in 409 survivors of 414 patients undergoing 440 consecutive bypass operations, were selectively opacified in multiplane cineangiograms prior to hospital discharge and 1132 (81%) were restudied at one year. Grafts were graded A (excellent), B (fair) or O (occluded) by separate assessment of proximal and distal anastomoses and bypass trunks. In early graft studies 89% were patent (A and B), 79% graded A; at one year, 81% were patent, 74% graded A. Circumflex-marginal grafts fared less well early, but similarly late, compared with other grafts. Of all grafts graded B early, 37% became A, 39% remained B and 24% were occluded at one year; 90% of early graded A grafts remained so, 4% became B and 6% occluded; the grading system seems to have had useful predictive value. Distal anastomosis defects dictated early B grading in 81.3% of cases, trunk defects in 12.5% and proximal anastomosis defects in 2.7%. Trunk defects carried a worse prognosis for occlusion than did distal anastomosis defects. Side-to-side, vein-coronary anastomoses had a significantly higher patency rate than terminal end-to-side coronary anastomoses with the same veins.

Adult↗
PubMed1975

Photographic maps for coronary artery operations: how to make them easily.

A modification of the Tagarno 35-mm ciné-film projector has been devised primarily for the cardiac surgeon, to produce excellent pictures of opacified coronary arteries. A combined screen and photographic holder allows the surgeon to view an image 10.2 X 12.7 cm and to make positive prints of selected frames in a matter of seconds. No photographic experience is needed.

Cineangiography↗
PubMed1972

Surgical treatment of impending myocardial infarction: report of two cases.

Two men, aged 29 and 44, presented with clinical and electrocardiographic evidence suggesting impending myocardial infarction. Selective coronary angiography revealed serious obstructive coronary atherosclerosis including gross stenosis of the main left coronary artery in both. Emergency surgical operations were performed, a double aorto-coronary venous bypass in one and a single venous bypass combined with a Vineberg operation in the other. Neither patient sustained myocardial infarction. Both patients are very well more than six months after operation. Clinical, electrocardiographic and angiographic evidence of the effectiveness of these operations is presented.

Adult↗
PubMed1972

Delayed diagnosis of symptomatic coronary artery disease in young men.

Delay in making the diagnosis of symptomatic coronary artery disease was determined by studying the medical histories of 265 men aged 24.7 to 49.9 (mean 40.1) years with angiographically proven obstructive coronary atherosclerosis. The diagnosis of angina pectoris was delayed three times as often as the diagnosis of myocardial infarction, and for five times as long. The diagnosis of symptomatic coronary artery disease was delayed three and a half times more often in patients less than 35 years of age, than in patients over 45; the average time from presentation with symptoms to diagnosis was 30 times longer in patients under 35 years of age than in patients over 45.

Adult↗