الفهرس 
I. INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Coronary artery bypass grafting (CABG) is the surgical revascularization procedure indicated for patients with ischemic heart disease especially if the left main coronary artery is affected and also in patients with muti-vessel disease. CABG has shown excellent survival results in certain subgroups with multi-vessel disease and in left main disease.
We can not expect that all patients will have improvement in LV function after CABG, but it is usual finding. Many variables and factors as the extent of hibernating or stunned myocardium affect LV function reversibility. Improvement and reversibility of LV dysfunction may occur immediately postoperatively and extend up to several years postoperatively as indicated by several studies.
Fifty patients indicated for CABG at Shark El Madina hospital were prospectively followed up at six months period post operatively in order to study the effect of CABG left ventricular function and the time course of recovery of ischemic myocardium
After CABG, we have noticed improvement of preoperative patient of angina pectoris, as the number of patients complaining from angina has decreased from 94% preoperatively to 10% at six months postoperatively. Also improvement of preoperative patient dyspnea occurred postoperatively, and this improvement was correlated well with improvement in left ventricular function.
Improvement in left ventricular function was especially noticed in patients with impaired function preoperatively. In our study, post-operative changes in LVEF ranged from -3% to 21%, which means that a significant increase in LVEF occurred in some patients.
We have observed that LVEF improvement occurred within the six months period of our study, although a longer time period may be needed for further improvement depending on some variables, such as the duration of hypo-perfusion.
Conclusion and Recommendations
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CONCLUSION AND RECOMMENDATIONS
(1) Surgical revascularization significantly improves both perfusion and contractility. The result of improved coronary perfusion after restoration of blood flow after CABG is improvement of the left ventricular systolic function. Objective documentation of improved LV function after CABG can be done by Echocardiography and is related to ischemic myocardium revascularization.
(2) CABG has a low mortality rate and largely improves patient symptoms and discomfort with the improvement in cardiac contractility.
(3) In patients with chronic ischemic heart disease, the alterations of LV volumes and geometry can be directly reversed by surgical revascularization of ischemic myocardium.
(4) The six months period from surgery to myocardial function assessment in our study appears to be adequate to allow good recovery of dysfunctional left ventricular myocardium and after CABG. We can not exclude further improvement of left ventricular function. So, further observation for more than six months of myocardial function may be needed.