In most instances of atherosclerotic heart disease the degenerative condition is diffuse and damages all principal ramifications of the coronary network. Surgical treatment, short of cardiac transplantation, could not be expected to remedy these widely-disseminated pathological disturbances, and is directed chiefly at palliation. Since the earlier operations of cardiosympathicolysis for relieving anginal pain, there has been a transition to ameliorating the vascular status of the ischemic myocardium by promoting blood flow through extracoronary and intercoronary auxiliary channels. The hemodynamic improvement is customarily accomplished nowadays by some form of cardiopexy or by implantation of a systemic artery into the ventricular myocardium. Several other attempted or proposed procedures have either fallen into disuse or await clinical trial.The disclosure from postmortem examinations that the coronary occlusive process is occasionally discrete and well-defined raised hopes that surgical extirpation of these blocks might be curative. Actually, the proportion of localized, chronic coronary obstructions
SCHECHTER DC, CACHERA J, PIWNICA A, DuBOST C. Experiences With a Method of Coronary Arteriotomy and Repair. Arch Surg. 1964;88(3):434–444. doi:10.1001/archsurg.1964.01310210108018
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