The selection of patients with angina pectoris for sympathectomy; With a report of additional cases

Abstract 1. 1. Some patients suffcring from angina have been strikingly helped by cervical sympathectomy. 2. 2. A proper selection of cases ought to diminish markedly the immediate surgical mortality, and this selection should be so directed that those who are operated upon continue to liver for an appreciable length of time to enjoy their improved health. 3. 3. It is absolutely necessary that accurate diagnoses be made and that cardiac infarction be not confounded with angina pectoris. Furthermore the study of each patient should indicate that there has not been any congestive heart failure, that the musculature of the heart is satisfactory and preferably that there is no valvular disease. 4. 4. A detailed report is made concerning seven patients who were selected for sympathectomy. They are all alive, three months to two years following operation. Three were rendered absolutely free from anginal attacks immediately and have remained so. Three continued to have typical anginal attacks after the operation but were nevertheless considerably improved, in that it required a greater effort to bring them on. One was made neither better nor worse. Of these latter four, three have since become practically free from attacks as a result of medical care. An eighth patient died on the day of the operation. It had been decided after careful study that he was a distinctly unfavorable case to be treated surgically, but because he was growing worse and life was becoming unbearable despite a ten weeks' course of medical care, including antisyphilitic treatment, the operation was performed although we were fully aware of its dangers. 5. 5. It is urged that cases be reported in detail so that one may judge as to the type of patient operated upon. 6. 6. In general it is felt that the operative measures for angina pectoris if carried out on properly selected patients are a distinct addition to our means of therapy.