De-Epicardialization: A Simple, Effective Surgical Treatment for Angina Pectoris

Abstract

Removal of the epicardium of the dog's heart with 95 per cent phenol permits anastomoses between pericardial vessels and the coronary arteries that are large enough to carry the Schlesinger mass (40 micra or larger). In 18 patients suffering from intractable angina pectoris an operation consisting of phenolization, instillation of talc and pneumonopexy has resulted in consistent relief of pain. The simplicity of the procedure exposes the patient to minimum risk of fresh thrombosis; its effectiveness justifies further trial.

Phenol topically applied to canine left ventricular epicardium interrupts sympathetic but not vagal afferents.

“…Harken et al (1955) used phenol on the surface of the heart to produce afferent denervation of the myocardium to treat intractable angina in patients. The sensation of myocardial pain is mediated by afferents traveling with the sympathetic fibers (White, 1957;Ueda et al, 1968;Uchida and Murao, 1974c;Nishi et al, 1977), so the assumption was made that phenol produced denervation.…”

“…These sympathetic afferent fibers mediate a pressor response and a pseudo-affective response in animals that can be elicited by epicardial application of bradykinin (Uchida and Murao, 1974a;Staszewska-Barczak et al, 1976), prostaglandins (Staszewska-Barczak et al, 1976;Baker et al, 1978), potassium in high concentrations (Uchida and Murao, 1974b;Nishi et al, 1977), or acid (Linden and Norman, 1969;Uchida and Murao, 1975). Sympathetic afferents also apparently mediate cardiac pain sensation in man (Lindgren and Olivecrona, 1947;Harken et al, 1955). Other afferent fibers travel with the vagus nerves and can be activated by epicardial application of nicotine (Kulaev, 1963;Sleight, 1964).…”

Failure of Encephaio-Duro-Arterio-Synangiosis Procedure in Moyamoya Disease

“…Before the current widespread use of coronary artery bypass surgery, a variety of indirect operations were advocated including: stimulation of adhesions be tween the pericardium and myocardium [17], pectoral muscle grafts [18], stomach, liver, spleen, omental and lung grafts [19,20], as well as the internal mammary artery implantation procedure [21]. None of these proce dures survived close scrutiny.…”

The Autonomic Nervous System in its Relation to Some Forms of Heart and Lung Disease: I. Heart Disease

“…Is this method of sympathetic ablation applicable to the cardiac nerves ? Judging by a few recent reports such as that of Harken et al (1955), and by some of our own patients at St. Thomas's, it is a satisfactory procedure, and direct painting of the epicardium with phenol prevents anginal pain in patients with ischaemc heart disease. In one of our patients, who subsequently died several months after this operation of a myocardial infarction, there were no vascular adhesions and his infarction was painless.…”