• Journal of Chest Surgery
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• v.37 no.7
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• pp.570-577
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• 2004

CT angiography is now available to evaluate the early graft patency after coronary bypass surgery. We investigated whether patency or occlusion of the bypass grafts can be visualized by CT angiography and what factors effect the visuality. Material and Method: Fifty patients underwent scanning with a 4-slice computed tomographic scanner (Somatom Volume ZoomTM; Siemens, Germany) before being discharged after coronary artery bypass grafting. To evaluate graft patency and relationship between the quality of graft image and the characteristics of the diseased coronary vessels, 50 internal thoracic artery grafts, 18 radial artery grafts, and 56 vein grafts were included in this study. Result: All vein grafts (24 grafts; 32 anastomoses) to left coronary artery system were well visualized, but 3 grafts (4.7%) of 30 vein grafts (35 anastomoses) to right coronary artery system were not visualized. The latter was also occluded in invasive coronary angiographic study. Thirty-nine (78%) internal thoracic artery grafts were well visualized, 8 (16%) faintly visualized, and 3 (6%) not visualized, but all the internal artery grafts were well patent in invasive coronary angiographic study. Conclusion: Unvisualized vein grafts in CT angiography means occlusion of the grafts, but unvisualized arterial grafts in CT angiography may not mean occlusion of the graft but result from competitive flow between the graft and coronary artery. To confirm patency of the unvisualized arterial grafts, invasive coronary angiography is needed.

• Journal of the Korean Society of Radiology
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• v.17 no.4
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• pp.589-595
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• 2023

If complete coronary artery occlusion occurs due to severer coronary spasm, malignant arrhythmias can lead to death. Therefore, early screening for coronary artery spasm angina is essential. Among the test methods, the drug injection test through coronary angiography is generally performed. Therefore, the purpose of this study was to evaluate the advantages of ergonovine drug test for vasospasitc angina examination during coronary angiography, such as the relationship between the procedure time, contrast medium usage, and radiation exposure effects of coronary angiography. Follow-up data of 142 patients who underwent coronary angiography and variant angina examination from september 2021 to february 2023 were used. As a result of analyzing contrast usage dose and dose area product and air kerma dose and number of imaging series and procedure time, variant angina examination was statistically significantly higher than coronary angiography. (p<0.001) In conclusion, variant angina examination other than coronary artery angiography are radiologically negative. Therefore, we think it is better to avoid excessive inspection. Nevertheless, in the case of the provocation test, the longer the examination time, the higher the fluoroscopy time and the amount of contrast medium used, so it is better to conduct the test as quickly as possible or shorten it.

• Journal of Chest Surgery
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• v.39 no.1 s.258
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• pp.42-47
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• 2006

Background: The new Multidetector Computed Tomography (MDCT) is useful in visualization of complex coronary artery anatomy. We investigated usefulness comparing of invasive coronary angiography with noninvasive MDCT in judgment of functional degree of coronary arteries grafts after coronary artery bypass graft operation. Material and Method: We analyzed the patency of 52 conduits from 15 patients whom consented to take both 32 Channel MDCT and coronary angiography from November 2003 to November 2004. Comparisons were performed for sensitivity, specificity, positive prediction value and negative prediction value between coronary angiography and 3 dimensional reconstruction image using MDCT. Result: The average graft used was 3.4 $\pm$ 0.8 per patient. Average heart rate during MDCT was 86/minute (Range, 60$\∼$110/minute) without administration of $\beta$-blocker. All patients could hold breath as much as necessary. The average graft patency obtained through corollary angiography was 96.2$\%$. In MDCT group, the sensitivity, the specificity, the positive predictive value and the negative predictive value for diagnosis was 100$\%$, 98.0$\%$, 100$\%$ and 66.6$\%$ respectively. Conclusion: The effectiveness of 32 Channel MDCT may be compared to coronary angiography in grasping about patency and bloodstream of graft conduits after coronary artery bypass graft. Also MDCT has the advantage of noninvasiveness and inexpensiveness compared to coronary angiography.

• Proceedings of the Korean Society of Radiological Science
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• 1993.05a
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• pp.27-28
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• 1993

• Journal of Chest Surgery
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• v.37 no.11
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• pp.897-902
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• 2004

Background: Although great concerns have been raised regarding the suitability of the use of the radial artery as a bypass conduit after transradial catheterization, there has been no studies that examined this issue in Korea. The purpose of this study was to compare clinical and angiographic results of radial artery grafting between patients with and without previous transradial catheterization. Material and Method: From January 2000 to February 2004, a total of 93 patients underwent coronary artery bypass grafting using the radial artery: 49 patients received preoperative transradial catheterization for coronary angiography (group I) and 44 patients did not (group II). These patients were retrospectively reviewed. Result: There was no significant difference in sex ratio, age, clinical diagnosis, risk factors, ejection fraction and early clinical outcomes between two groups. The graft patency rates in groups I and II were both 100% in the internal thoracic artery and in the radial artery, and 85% and 86% in the saphenous vein. respectively. The stenosis-free graft patency in groups I and II were 93% and 81% in the radial artery respectively but no statistical significance was shown. Conclusion: There was no significant difference in graft patency at postoperative coronary angiography between two groups. Radial artery graft after transradial catherization seems to be suitable for bypass conduit in short-term analysis.

• Journal of Chest Surgery
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• v.38 no.11 s.256
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• pp.733-738
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• 2005

Background: The possibility of incomplete revascularization and development of flow competition after revascularization of the borderline lesion made the hybrid strategy as an option for complete revascularization. Material and Method: From January f998 to July 2004, 25 $(3.2\%)$ patients underwent hybrid revascularization among 782 total OPCAB procedures. Clinical results and angiographic patencies were evalulated. Percutaneous coronary intervention (PCI) was peformed before CABG in 8 patients and after CABG in 47 patients. Result: The causes of PCIs before CABG were to achieve complete revascularization with minimally invasive surgery (n=7) and emergent PCI for culprit lesion (n=1). The indications of PCIs after CABG were high possibility of flow competition in the borderline lesion of right coronary artery territory (n=8), diffuse atheromatous lesion preventing anastomosis of graft (n=5), severe calcified ascending aorta with no more arterial grafi available (n=3), and intramyocardial coronary lesion (n=1). Mean number of distal anastomoses was $2.3\pm1.0$. Mean number of lesions treated by PCI was $1.2\pm0.4$. There was no operative or procedure-related mortality. PCI-related complication was periprocedural myocardial infarction in one patient, and complications related to CABG were transient atrial fibrillation (n=5), perioperative myocardial infarction (n=1), and transient renal dysfunction (n=1). Early postoperative coronary angiography $(1.8{pm}1.6days)$ revealed $100\%$ patency rate of grafts (57/57). The stenosis occurred in one patient performed PCI before CABG, which was successfully treated with re-ballooning. During midterm follow-up (mean; $25{\pm}26$ months), 1 patient died of congestive heart failure. All survivors (n=24) accomplished follow-up coronary angiographics, which showed .all grafts (56/57) were patent except one string sign. In-stent restenosis was developed in 2 patients who received bare metal stents. Conclusion: In selected patients, complete revascularization was achieved with low risk by taking the hybrid strategy.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.182-187
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• 2002

Background: There have been many reports of coronary angiographic findings after coronary bypass grafting, most of which are focused on the graft patency rate of the bypass conduits. However, postoperative angiography can provide numerous informations other than patency rates that are useful for establishing operative strategy. Material and Method: We studied 73 patients in whom coronary angiography was done after more than 1 month of CABG. Mean interval from the operation to coronary angiography was 10.6 months and the reasons for coronary angiography follow up were residual or recurrent angina in 54 patients, abnormalities on myocardial perfusion scan or echocardiography in 13 patients, and for simple follow up in 6 patients. Result: Overall graft patency rate was 80.9% (internal thoracic artery 100%, saphenous vein 75.0%) in patients of simple follow up and 61.6%(internal thoracic artery 81.1%, saphenous vein 55.3%) in patients with ischemia. Progression of native coronary arterial disease proximal to the grafting site was found in 50 patients(68.5%). Among 201 coronary arterial branches that had not been completely occluded preoperatively, ninty five branches(47.3%) revealed progression of diameter stenosis by more than 20% on the follow up study. Among them, 64 branches(31.8%) progressed to total occlusion. The incidence of disease progression was highter in the coronary arteries with patent grafts(57.5%) than in those with occluded grafts(36.3%)(p<0.05), Comparing internal thoracic artery graft with saphenous vein graft, internal thoracic artery was superior to saphenous vein, not only in terms of patency(83.3% vs 56.6%), but also in terms of result of later percutaneous intervention success rate(100% vs 62%, p<0.05). Conclusion: Due to the considerable incidence of progression of native coronary artery stenosis in the early postoperative periods, bypass grafting of a vessel with borderline stenosis, especially with vein graft, must be done prudently. And it was confirmed again that revascularization of left anterior descending artery is most important and that internal thoracic artery was superior to saphenous vein.

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.759-764
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• 2006

Background: We analyzed post-operative angiography performed in symptomatic patients to evaluate the patency rates and the roles of grafts. Material and Method: We reviewed 52 (15%) coronary angiograms performed for recurrent angina after prior coronary artery bypass surgery from January 1995 to June 2005. A total of 345 patients underwent coronary artery bypass surgery during this period. There were 41 men and 11 women and the mean age was $64.07{\pm}15.58$ years. The median period from operation to re-angiogram was 68.5 months (range, 1 to 126 months). The numbers of grafts and peripheral anastomoses were 42 and 43 for internal thoracic artery (ITA), 14 and 20 for radial artery (RA), and 49 and 89 for saphenous vein. The mean number of anastomosis was 2.9 per patient, Result: The patency rates of ITA, RA and saphenous vein graft (SVG) were 37/43 (86%), 17/20 (85%) and 34/89 (38.2%). The patency rate of arterial grafts was significantly higher than that of SVG (p< 0.001) and the patency rate of the RA was comparable to that of ITA (p=0.942). The patency rate of sequential SVGs was higher than that of single SVG (40.3% vs 31.8%, p=0.478) and the patency rate of proximal segments in sequential anastomosis was higher than that in single anastomsis (55.6% vs 31.8%, p=0.097), but statistically not significant. Conclusion: Arterial grafts have markedly superior patency rates than SVGs, so consideration should be given to the vigorous use of arterial grafts. The patency rate of the RA was comparable to that of ITA.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.944-947
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• 2001

Coronary artery involvement in Takayasu's arteritis is a relatively rare, and potentially lethal but surgically correctable disease. A 28-year-old female was admitted for the evaluation of headache associated with dizziness, palpitation and claudication of left arm. Her aortogram and coronary angiogram showed Takayasu's arteritis with bilateral coronary ostial stenosis. We performed bilateral coronary ostioplasty with saphenous vein patch graft. The patient was discharged in good condition. We report this case with literature review.

• The Journal of the Korea Contents Association
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• v.9 no.12
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• pp.339-347
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• 2009

Purpose : This study was to investigate the influence of heart rate and coronary calcification on diagnostic accuracy of 64-slice multidetector CT(MDCT) in coronary artery disease. Methods : 178 patients(84 men, 94 women) undergoing cardiac CT were included in this study. 3 coronary arteries(LAD, LCX, RCA) were assessed the presence of significant stenosis($\geq50%$) and the results compared with those of coronary angiography. Results : On a patient-based analysis, the diagnostic accuracy of 64-slice MDCT was 96.6%. The diagnostic accuracy on left anterior descending, left circumflex, right coronary artery were 86.5%, 84.3%, 92.1% respectively. Body mass index and blood pressure were not influenced on diagnostic accuracy of 64-slice MDCT. In less than 60/min of heart rate, accuracy was 90.1% and $\kappa$ value was 0.78. While in more than 70/min of heart rate, accuracy was 75.8% and $\kappa$ value was 0.52. In less than 100 of coronary calcification, accuracy was 91.3% and $\kappa$ value was 0.81. While in more than 400, accuracy was 68.6% and $\kappa$ value was 0.33. Conclusion : 64-slice MDCT shows similar diagnostic accuracy as coronary angiography. But in the context of more than 70/min of heart rate and 400 of coronary calcification, diagnostic accuracy was decreased. So there needs to identify heart rate and coronary calcification in cardiac CT, and if heart rate shows more than 70/min, use beta-blocker to regulate it.