Internal Mammary Artery Implantation: Effect on Myocardial Lactate Utilization

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Abstract
Twenty-three subjects with angiographically documented coronary heart disease were studied by means of arterial and coronary sinus catheterization before and one year after internal mammary artery implantations. The pre- and postoperative patterns of lactate extraction at rest and after isoproterenol stress have been determined and correlated with clinical improvement and angiographic patency of the implant. In group I 13 subjects had implants that were angiographically seen to fill some portion of the coronary circulation. Eight of 11 who produced lactate preoperatively reverted to normal lactate extraction. Two extracted lactate at both studies. All but two had clinical improvement. No deaths occurred over a mean follow-up period of 40 months (range 20 to 64). In group II ten subjects bad implants with no visible connection to the coronary circulation. Only one subject had reversion of lactate production to extraction and two from extraction to production. Seven of ten did not improve clinically. Three deaths occurred over a mean follow-up period of 39 months (range 17 to 53). Agreement has been found between reversion to normal lactate metabolism, angiographic patency, and clinical improvement following internal mammary artery implantation.

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