[Indications and counterindications of aortocoronary bypass]

The author systematized the indications for aortocoronary shunting in ischemic heart disease on the basis of complex evaluation of the patient's condition with obligatory consideration for the clinical picture of the disease, the condition of the coronary channel, and the left ventricular myocardium. An absolute indication for the operation is Functional Class II-IV angina pectoris with multiple affection of the coronary channel or stenosis of the trunk of the left coronary artery and maintained or moderately diminished function of the left ventricle. Radiologically-guided endovascular dilatation of the narrowing is first indicated for patients with stenosis of one or two coronary arteries. The main principle in operation in ischemic heart disease is attainment of complete revascularization of the myocardium by shunting all arteries measuring more than 1 mm in diameter which are stenosed by 50% and more. The main contraindications for the operation on the part of the heart are diffuse or distal affection of the coronary arteries, a more than two-fold reduction of ejection fraction as compared to the normal value, Stage IIB-III circulatory insufficiency.