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To evaluate the behavior of circulating endothelin and atrial natriuretic peptide (ANP) during coronary artery bypass graft (CABG) surgery, blood samples from patients with coronary artery disease (n = 8) were investigated before, during and after operation. Plasma levels of endothelin and ANP were determined using the radioimmunoassay method. Baseline plasma levels were compared to those of normal volunteers (n = 6). Left ventricular function at rest and as a response to isometric exercise was evaluated using radionuclide ventriculography before and after coronary bypass surgery. The mean endothelin value was found to be within normal limits, however the mean ANP value was slightly higher than control. Patients had significantly improved left ventricular systolic and diastolic function after surgery. The mean endothelin level was higher than initial values immediately after extra-corporeal circulation and returned to initial values in two hours. However, ANP values were increased and remained higher than initial values. Baseline endothelin values were negatively correlated with systolic function parameters, whereas endothelin and heart rate had a positive correlation before extra-corporeal circulation. Coronary artery bypass graft surgery may cause an increase in the circulating endothelin level either due to endothelial injury or due to myocardial ischemia and hypothermia. Following surgery, increased endothelin levels returned to normal values immediately.

Late stenosis is a rare but potentially lethal complication of coronary perfusion. In 3 patients, anginal pain appeared 2 to 6 months after aortic valve surgery. Coronary angiography was performed because of rapid evolution of symptoms. Severe stenosis of the common left coronary artery was shown in all 3 cases. Immediate aorto-coronary bypass was undertaken with good results. Graft patency was demonstrated in 2 cases, 6 and 7 months after the operations.

22 patients with atheromatous narrowing of the left coronary trunk underwent surgery between 1969 and 1974. Most of these patients had severe and incapacitating angina pectoris. The clinical features are readily explained by the size of the diffuse anatomical lesions, which are to be found on the left coronary trunk as well as on the three coronary vessels themselves. This series has not confirmed the serious risk of surgery in such cases, as there were no operative deaths. Secondary mortality was low (9%), and the 20 survivors (average length of follow-up: 26 months) were mostly (18/20) in an excellent condition functionally. These facts have lead us to advise surgery whenever possible.

The authors report five cases of stenosis of the trunk of the left coronary artery following cannulation of the coronary artery, and discuss the types of lesion, and whether they exist as an entity. The morbidity of these lesions, and the threat of sudden death which they pose, indicates an aggressive treatment plan: - definite angina occurring 2 to 6 months after aortic surgery (under coronary artery perfusion) is an indication for urgent coronary arteriography; - this investigation must be followed by a revascularization procedure within a few days if it shows a tight stenosis of the coronary trunk. The constant finding of a good vascular bed distally would seem to presage good long-term results.