title: Improvement of Left Ventricular Function and Wall Motion Abnormalities after Recanalization of Total Occlusion of Left Anterior Descending Coronary Artery by Percutaneous Transluminal Coronary Angioplasty.
abstract: PTCA was performed in 262 consecutive patients (pts) with total LAD occlusion. TIMI 3 flow was established in 164 pts (success rate was 62.6%). After 4Ð6 months a follow-up angiography of 72 pts showed restenosis in 39 pts (restenosis rate was 54.2%). In 33 pts without restenosis there was a significant increase in ejection fraction (EF) (54.6 +/- 15 versus 59.8 +/- 18.1 before and after PTCA respectively, p = 0.02). Improvement of wall motion abnormalities (WMA) in 12 of 26 pts was observed. Anterolateral-apical (AL-A) aneurysm disappeared in 6 pts and limited to apex in 2 pts. AL-A hypokinesia in 3 and akinesia in 1 reversed to normal wall motion (NWM). There was not a significant change in EF in either of the groups of pts with reocclusion (24 pts) or restenosis (15 pts) (p > 0.05). However, AL-A aneurysm disappeared in 2 of 12 pts with WMA before PTCA although there was restenosis (but TIMI 3 flow) on follow-up coronary angiogram. In 3 pts with restenosis but not reocclusion AL-A hypokinesia, akinesia and apical dyskinesia returned to NWM. No significant changes were observed in the left ventricular end diastolic pressures (LVEDP) in both pt groups with or without improvement of WMA(p > 0.05). Filling fractions (FF) did not change in patients with or without restenosis. CONCLUSION: The observations in patients with successful total LAD occlusion angioplasty and no restenosis are as follows: 1) There was a significant increase in EF; 2) There was no significant decrease in LVEDP and no increase in FF; 3) The rate of improvement of WMA was 46.2%; 4) There was no relation between improvement of WMA and the age of occlusion, the grade of coronary collateral vessels and involvement of other coronary arteries. However, it has been emphasized that in 11 of 12 pts (91.6%) with improvement of WMA the age of occlusion was < 3 months, in 10 (83.3%) the grade of coronary collateral vessels was 2 or 3 and in 10 (83.3%) the other coronary arteries were normal. The improvement of WMA in 41.6% of pts. who had also subtotal restenosis but not reocclusion was observed. Finally in 72 pts with follow-up coronary angiography, the rate of improvement of wall motion was 23.5 %.
authors.affiliation: Mesa Koru Sitesi, Gul Blok No. 29, 06530, Ankara, Turkey.
authors.initials: G
authors.lastname: Pamir
authors.initials: D
authors.lastname: Oral
authors.initials: K
authors.lastname: Omurlu
authors.initials: C
authors.lastname: Erol
authors.initials: C
authors.lastname: Kervancioglu
authors.initials: G
authors.lastname: Akgun
authors.initials: Z
authors.lastname: Golbasi