Periaortic denervation in reconstructive surgery of coronary vessels

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.