Sympathetic denervation in association with coronary artery grafting in patients with Prinzmetals' angina.

Myocardial revascularization in patients with Prinzmetal's angina has yielded variable results. Two patients are presented who underwent partial cardiac sympathectomy in combination with coronary artery grafting for typical variant angina associated with severe organic obstructive coronary artery disease. Late results 12 and 18 months postoperatively have been excellent in both instances as shown by clinical and angiographic evaluation. Although the exact mechanism responsible for Prinzmetal's angina is not known, it is believed that spasm through increased activity of vasomotor tone or of the autonomic nervous system plays a major role. Since this variant form of angina encompasses a whole spectrum at angiography, ranging from normal arteries to severely narrowed ones, including those with spasm, it is suggested that surgical treatment be planned accordingly. Thus, in patients who have organic stenoses with and without spasm, operative treatment may consist of removal of the preaortic or pretracheal plexus in association with conventional coronary artery grafting. In patients who have intractable episodes of ventricular arrhythmia or angina and who angiogram is normal or shows isolated spasm, coronary artery grafting should be abandoned, in view of the poor results reported in the literature in these circumstances, and cervicothoracic sympathectomy should be considered.