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In 305 patients operated upon for symptomatic ischaemic heart disease, a series of resting electrocardiograms, obtained during the first days after operation, was evaluated. A new Q wave was found in 10% of the patients. The genesis of this EGG change had not correlation with the patients' age and sex, presence of hypertension and diabetes mellitus, tobacco smoking, blood cholesterol level, functional calss of angina pectoris, previous myocardial infarction, the number of affected coronary arteries, duration of extracorporeal circulation or anoxic circulatory arrest, and peroperatively measured graft blood flow. A new Q wave after revascularization occurred more frequently in patients with multiple venous aortocoronary bypasses. The new Q wave is an EGG manifestation of myocardial necrosis with subsequent local disturbance of left ventricular function.

Stimulation of sympathetic nervous conductive pathways and ganglia innervating the heart leads to a sudden increase in the cardiac performance and to a qualitative change in the phasic blood flow within the coronary vascular bed. This so-called malignant increase in the blood flow is accompanied by relative coronary insufficiency and increased mechanical stress imposed upon the coronary arteries. A denervation operation according to Arnulf does not prevent the propagation of excitation from the right stellate ganglion to the heart. A complete denervation is obtained by additional cutting of the right-side postganglional fibres. Then in a dog no changes occur in the coronary arterial blood flow measured at rest during the operation. In reconstructive surgery of coronary vessels in man, after denervation the peroperative blood flow in the aortocoronary bypass to the anterior interventicular branch increases. After a surgical denervation operation, the prevention of propagation of sudden neurogenic stimuli via the cervical sympathetic segment to the heart ventricles is the most striking result. Such a "protection" of the heart might retard the development rate of coronary insufficiency accompanying the ischaemic heart disease.

The paper deals experimentally with the influence of the blood flow on the long-term fate of venous grafts in the arterial circulation. Based on the results of experiments, and applying the laws of haemodynamics, the paper provides evidence that the blood flow has a decisive influence on the behavior of the implanted vein. Veins with a mean flow of 364.5 ml/min, dilate by 70% while the external diameter of veins with a mean flow of 65.4 ml/min. remain without major changes. This difference in the behaviour is statistically significant at the 1% level. From the results ensues that the vein is suited for reconstructions where a blood flow of 50--200 ml/min. may be expected.

The authors analyzed the fate of 234 patients 1--6 years after operation of the coronary arteries. In the majority of patients they recorded alleviation of complaints and improved physical performance. Part of the patients resumed employment. Successful revascularization of the heart muscle improved the mechanical function of the left ventricle. Indirect comparisons suggest that the number of patients who survived late myocardial infarction and late mortality are lower in operated patients than in similar patients treated only conservatively. Final evaluation of all possible methods of surgical treatment of the coronary arteries will call for further work. The experience as regards indications, surgical tactics and techniques in postoperative care assembled during the past period improve fundamentally the immediate results of surgical treatment of coronary artery disease and this must be manifested also in the subsequent fate of these patients.

Indications for reconstruction operations in the region of branches of the arch of the aorta must be based on a comprehensive evaluation of the neurological and angiographic finding and the general condition of the patient. This ensues from the experience assembled in more than 800 operations performed since 1959. To evaluate the surgical risk, a scoring system was elaborated which evaluates the partial risks of each basic aspect of indication. Based on the sum of partial risks, four grades were defined. Patients who meet the prerequisites for surgical risk I and II (mainly with transient ischaemic attacks and asymptomatic stenoses of the internal carotid artery) can be indicated, with regard to hitherto assembled results, unequivocally for reconstructions. In grade IV risk it is essential to consider whether the risk of the natural course is greater than the risk of the operation and whether the affection of the afferent cerebral artery is the main limiting factor. The authors discuss contemporary views on indications of acute reconstructions of stenoses and occlusions of the internal carotid artery based on the neurological and angiographic factor and the time factor. From the evaluation of results of 92 urgent operations on account of recent or imminent symptoms of cerebral ischaemia ensues that for the result the grade and dynamics of the ischaemic cerebral affection at the time of the operation are decisive.

The authors discuss contemporary problems of resection of post-infarction cardiac aneurysms. In their opinion the main cause of left-sided cardiac failure is enlargement of the left ventricle which leads to increaser demands on the tension of muscle fibres and work of the heart. These mechanisms potentiate at the same time the ischaemia of the heart muscle. Reduction of the left ventricle by appropriate resection eliminates or improves markedly this adverse condition in particular when there is an opportunity of simultaneous revascularization by an aorto-coronary by-pass. Based on the results in a series of 52 operations the authors consider assessment of the stroke volume before and after the foreseen resection a suitable and reliable criterion for indication of the operation. Its application led to a substantial decline of the surgical mortality caused in particular by the postoperative low cardiac output syndrome.

Five years ago we reported on a technique of direct arterial anastomosis with the cavernous bodies of the penis. At that time we expressed the hypothesis that in some cases impotence could be the result of organic changes in the arterial bed supplying the cavernous bodies. A histological study was therefore performed on postmortem material and a new arteriographic technique - phalloarteriography - was developed to visualize the internal pudendal artery, the penile artery and its branches. Bilateral examination carried out in 132 patients with erectile impotence established stenosis or occlusion of these arteries or aplasia of the deep penile artery in most of them. Stenoses or occlusions were either of traumatic (after pelvic fracture) or sclerotic origin in middle aged and older patients or were related to diabetes. In more than 20% of patients with occlusions in the arterial bed plastic induration of the penis (Peyronie's disease) was found. Phalloarteriography has become the basic technique of surgical indication and approach. Revascularization procedures consisted of anastomosis of the inferior epigastric artery to the dorsal penile artery or directly to the cavernous bodies. The results attained in the first 54 patients confirmed the vasculogenic origin of their impotence. The development of phalloarteriography and revascularization procedures contribute to surgical management of impotence and extend the use of vascular surgery.

The authors describe various denervation operations, and based on their findings, propose their own method of aimed sympathetic denervation of the heart. The results assembled in acute and chronic experiments on dogs indicate that by this operation the sympathetic activation of the heart during adequate physical strain is suppressed; this does not occur, however, in complete ischaemia of the brain. Vagus innervation of the heart is also preserved and thus also the parasympathetic regulation of its rhythm. The authors discuss the importance of aimed sympathetic denervation of the heart for the surgical treatment of ischaemic heart disease.