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Sudden occlusion of the left anterior descending branch approximately 2 cm. below the ostium of the left circumflex coronary artery in the dog's heart produces a mortality rate of approximately 50 per cent. In dogs weighing approximately 15 kilos surviving more than 24 hours (average 1 week), an infarction is produced which almost invariably measures 5 x 5 cm. on surface. Following coronary sinus obturation such secondary sudden occlusion of the left anterior descending branch is followed either by no infarction or by a reduction in the size of the infarct. The success of the procedure, quite apart from the mortality rate, depends upon the completeness of the coronary sinus obturation. On the other hand, sudden and complete coronary sinus obturation by itself is associated with a high operative mortality and apparently does not affect the mortality rate following subsequent sudden left anterior descending branch occlusion. Partial persistent obturation of the coronary sinus, however, is in itself associated with a low operative mortality. Furthermore, its experimental production in dogs appears to lower the mortality rate following subsequent sudden occlusion of the left anterior descending branch and to diminish the extent of the infarction. In the introduction to this report it was pointed out that there are three important desiderata to the problem of improving the coronary circulation in the human heart. The findings herein reported fulfill these requisites to an encouraging degree. It has been shown that following the outlined procedures, a functional increase in the blood supply to the heart can be produced in a significant proportion of experimental animals, this varying with the nature of the experimental procedure. The manipulation is simple, can be performed in the dog within approximately 20 minutes, and does not lead to appreciable pericardial adhesions. Increase in the nutrition of the myocardium is noted 1 week after the experimental procedure. Although no experiments employing sudden left anterior descending coronary branch occlusion were carried out sooner than 1 week, there is available anatomic evidence that within possibly 24 hours after coronary sinus occlusion a dilatation of the vascular bed occurs. In subsequent experiments attempts will be made to determine whether this early vascular dilatation is adequate to compensate for subsequent sudden left anterior descending branch occlusion. A discussion is given of the results following various coronary sinus occlusion procedures in which it is indicated that it is desirable to produce a partial or gradual occlusion in order to lower the mortality rate both of the initial procedure as well as of the subsequent sudden arterial occlusion. Experiments thus far reported on cardiopexy operations are lacking in evidence that they are associated with appreciable improvement in the vascular nutrition of the myocardium.
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