Myocardial Revascularization and the Internal Mammary Artery
The first approach for treatment of coronary artery disease was through the sympathetic nervous system. As early as 1899, Francois-Franck in France suggested a sympathectomy to relieve the pain of angina pectoris. Jonnesco (1920) performed a cervical thoracic ganglionectomy in 1916 as the first planned surgical attack on coronary artery disease, with the idea of increasing the blood flow to the heart by coronary artery vasodilatation. This however did not prove to be effective (McEachern et al. 1940) and the major role of cardiac denervation is relief of anginal pain. Other methods of cardiac denervation have been suggested such as pericoronary neurectomy (Fauteux and Swensen 1946), section of the preaortic plexus (Arnulf 1948), posterior rhizotomy (White 1955), and paravertebral nerve block (Mandl 1925). The disadvantage of these procedures, most of them with considerable surgical risk, remains the fact that they do not attack the basic coronary obstructive process. Different indirect approaches for reduction of angina pectoris such as surgical or medical 131I thyroidectomy to reduce cardiac workload (Boas 1926; Blumgart et al. 1933) and carotid sinus nerve stimulation to reduce the heart’s energy consumption (Braunwald et al. 1967) were also attempted.
KeywordsCoronary Artery Bypass Grafting Saphenous Vein Internal Mammary Artery Saphenous Vein Graft Myocardial Revascularization
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