• Journal of Chest Surgery
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• v.30 no.12
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• pp.1190-1196
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• 1997

Between July 1994 and August 1995, 78 patients underwent coronary artery bypass graft at Seoul National University Hospital. Coronary angiogram was performed one year after coronary artery bypass graft in 49 patients(62.8%) for evaluation of the graft patency and analysis of the risk factors for graft occlusion. The patency rates of both the internal mammary artery and the radial artery grafts were 100% , although three internal mammary artery grafts(5.0%) were narrowed(string sign). And that of the saphenous vein grafts were 85.2%. Multivariate analysis for the preoperative, operative, and postoperative factors was done between the widely patent and the narrowed internal mammary artery graft groups, and between the patent and the occluded saphenous vein graft groups by the general linear models procedure. Patient's age($\geq$60 years), postoperative intraaortic balloon pump insertion, bleeding, and acute renal failure were found to be the significant risk factors for internal mammary artery graft narrowing, and coronary artery size(< 1.5 mm) was the significant risk factor for the saphenous vein graft occlusion (p<0.05) . This study confirms that the arterial graft is superior to the vein graft at one-year patency rate, and suggests the risk factors for graft occlusion during the first postoperative year. Knowledge of this study may provide a basis for estimating the risk factors for graft occlusion, and thereby modifying surgical strategy and postoperative surveillance.

• Proceedings of the KTCVS Conference
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• 1996.10a
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• pp.55-55
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• 1996

• Journal of Chest Surgery
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• v.37 no.6
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• pp.511-516
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• 2004

Background: One of the theoretical advantages of skeletonized internal mammary artery harvesting in coronary artery bypass surgery is to minimize the interruption of the sternal blood flow inevitably accompanied by internal mammary harvesting. A study using bone scan is designed to determine the effects of internal mammary artery harvesting technique on the sternal blood flow. Material and Method: From April 2002 to March 2003, 27 patients out of 48 patients who underwent the isolated coronary bypass surgery were enrolled into the study. The enrolled patients underwent bone scan in the preoperative period and postoperative period respectively. Bilateral internal mammary artery was used in 8 patients (BIMA group) and single left internal mammary artery in 19 patients (LIMA group). The patients in LIMA group were divided into two groups: LlMA_skel group, in whom left internal mammary artery was harvested in skeletonized fashion (n=12), and LlMA_ped group, in whom left internal mammary artery was harvested in pedicled fashion (n=7). After the bone scan, the region of interest (ROI) was created on the left of the sternum and the mirror image with the same pixel numbers was placed on the right half of the sternum. The mean counts per pixel on the left side of the sternum was compared with those on the right side and expressed as left to right ratio (L/R ratio). Result: In LIMA group, the L/R ratio decreased from 94.6$\pm$4.1% to 87.9$\pm$6.9% (p=0.003) after the operation as compared to BIMA group, in which no change of the L/R ratio was observed. The changed of the L/R ratio in LlMA_skel group and LlMA_ped group were from 95.3$\pm$4.2% to 88.3$\pm$7.7% and from 93.4$\pm$3.9% to 87.4$\pm$5.8% respectively. The % changes in L/R ratio were -7.44 $\pm$7.08 in LIMA_skel group and -6.17$\pm$9.08 in LiMA_ped group, which did not reach the statistical difference. Conclusion: Ipsilateral sternal blood flow is interrupted by internal mammary artery harvesting as evidenced by the decrease in L/R ratio after left internal mammary artery harvesting irrespective of the harvesting techniques. Skeletonized harvesting did not show superiority in respect to sternal blood flow as compared to pedicled harvesting.

• Journal of Chest Surgery
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• v.26 no.2
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• pp.148-153
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• 1993

To compare two methods of mammary pedicle graft preparations with free internal mammary artery flow, we studied 31 patients who had the left internal mammary artery harvested for coronary artery bypass grafting. The free flow was measured at the transected opening of 2 to 3 cm distal to the point of bifurcation on mean arterial pressure of 50 to 55 mmHg during cardiopulmonary bypass. Group I comprised 14 patients, whose grafts were sprayed and wrapped in sponges soaked in diluted papaverine solution (60 mg in 40 ml Hartmann's solution). An average 80 minutes after the preparations, free flow of the internal mammary artery ranged from 20 to 80 ml/min (mean 37.7 ml/min). Group II comprised 17 patients, who had internal mammary artery takedown under the exact conditions used in group I. The grafts were sprayed and wrapped in sponges soaked in the diluted papaverine solution as in group I. After an average of 28 minutes, free flow ranged from 8 to 28 ml/min (mean 17.6 ml/min). Intraluminal papaverine of the same dilution was then injected without any hydrostatic dilatation and flows increased upto 37 to 150 ml/min (mean 74.7 ml/min). This study shows that intraluminal papaverine preparation method markedly increases free mammary artery flow which is inadequate with external papaverine preparation.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.831-834
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• 1999

The Kawasaki disease has been reported worldwide since the first description in 1967 in Japan. Approximately 20% of the children with untreated Kawasaki disease are believed to develop coronary artery aneurysm of which 2-3% progress to coronary artery stenosis. The Kawasaki disease rarely affects adults and accordingly, there have been only a few cases reported in literatures. The present case describes a successful surgical treatment of a 43-year-old female patient with coronary artery aneurysm and stenosis, which resulted from an episode of the Kawasaki disease that occurred 20 years earlier. The patient was well at 5 months followup.

• Journal of Chest Surgery
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• v.31 no.9
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• pp.884-892
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• 1998

Background: The gastroepiploic artery is not only an alternative graft but also may be considered an important primary graft for coronary revascularization. However, the long-term patency of the gastroepiploic arterial graft is yet to be determined and the incidence of perioperative spasm and long-term patency of a coronary graft may be affected by the properties of the graft response to certain vasoactive substances. The reactivity of the gastroepiploic artery to vasoactive substances has not been studied extensively and the results of the studies are contradictory. Material and Method: This study was designed to test the reactivity of human gastroepiploic artery to four constrictors and four relaxants. The middle sections of the human gastroepiploic arteries were collected from the patients undergoing gastrectomy and the arterial rings with intact endothelium were suspended in organ baths for isometric tension recording. Result: Epinephrine, norepinephrine, and potassium chloride induced the maximum constriction to higher forces (7.0$\pm$1.1g, 6.6$\pm$0.9g, and 6.5$\pm$1.1g) than 5-hydroxytryptamine did (3.8$\pm$1.7g, p<0.05). Nitroprusside and histamine induced almost full relaxation in the gastroepiploic arteries preconstricted with norepinephrine. There was no significant difference between two relaxants regarding maximum relaxation force. Acetylcholine induced the maximum relaxation to weaker force when compared with nitroprusside and histamine (p<0.05), and isoproterenol was the weakest of the relaxants (p<0.05 compared with acetylcholine). Conclusion: The gastroepiploic artery has a strong capacity of endothelium-dependent relaxation which could have an important influence on long-term patency. The gastroepiploic artery exhibits a potent contractility to catecholamines and the enhanced contractility may facilitate vasospasm in the presence of high circulating levels of catecholamines. Nitroprusside, a potent relaxant in gastroepiploic artery, might be beneficial for the treatment of gastroepiploic arterial graft spasm. The gastroepiploic arterial graft with intact endothelium may respond weakly to beta-adrenoceptor agonist and 5-hydroxytryptamine.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.133-136
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• 2008

Injury to the internal mammary artery secondary to blunt chest trauma is a rare condition. It is also uncommon to see extraplerual and mediastinal hematoma in these circumstances; this demands early diagnosis and active treatment. We report here on a 59 year old man who underwent surgery for extraplerual and mediastinal hematoma, and this was all due to injury of the internal mammary artery after blunt chest trauma. We also include a review of the relevant literature.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.693-701
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• 1999

Recently non-invasive diagnostic imaging replaced the invasive catheter angiography in the diagnosis of vascular disease. Catheter methods are now almost confined to the purpose of intervention. Coronary artery or coronary artery bypass graft still needs catheter technique because of small diameter and the cardiac motion. The last challenge for radiologists in this domain is to obtain a non-invasive imaging. Electron beam tomography(EBT) for high temporal resolution is able to obtain a coronary arteriogram or coronary artery bypass graft (CABG), of which CABG imaging is quite useful for the evaluation of patency. In our experience as well as others, the accuracy of EBT angiogram in evaluating CABG patency revealed that the accuracy of patency of saphenous vein grafts(SVG) is high due to relatively wide lumen, short and straight course and less influence from cardiac motion. The sensitivity and specificity of patency of SVGs were 92%, 97% respectively in the prospective evaluat on and 100% each in the retrospective evaluation. A false positive and a false negative case are rudimentary errors in the initial learing period. In contrast the analysis of left internal mammary artery(LIMA) graft was difficult due to the inherent small size and the adjacent surgical clips provoking beam-hardening artifact; therefore, the method of combining 3 dimensional reconstruction and flow mode study was important in improving the accuracy of LIMA patency. The sensitivity and specificity of LIMA patency were 100% and 80% in both prospective and retrospective evaluation. Therefore, EBT angiography is an accurate non-invasive diagnostic modality for evaluating the patency of CABG, particularly in SVGs. The accuracy can be improved with the improvement of the EBT and the development of the image reconstruction software.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1132-1135
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• 1997

We have experienced two cases of coronary revascularization without extracorporeal circulation in a 63 year old female patient and a 75 year old male patient. The first patient had the lesion which was the nearly total occulusion of mid-LAD, about 90% luminal narrowing of second diagonal branch and less than 50% stenosis of proximal RCA. The other male patient had a single vessel disease involving about 95% stenosis of proximal LAD and 1st diagonal branch. PTCA failed in the irst patient because of relatively long sinus pause during procedure In both of the patients, the coronary revascularizations were done at distal LAD and diagonal branch using left internal mammary artery and saphenous vein graft under the beating state, respectively. The postoperative courses were uneventful and the patients were discharged without any complications.

• Journal of Chest Surgery
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• v.30 no.8
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• pp.823-826
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• 1997

Myocardial abscess usually occurs as a complication of infective endocarditis or overwhelming septicemia. Coronary artery occlusion caused by myocardial abscess has been rarely reported. A 61-year-old man presented with fever and chill that developed 6 weeks prior to admission. He had a history of cardiopulmonary resuscitation for ventricular fibrillation and cardiac arrest 4 weeks prior to admission. Echocardiography showed a 3xfcm sized mass in the area of the right atrioventricular groove and coronary angiography showed complete occlusion of the proximal right coronary artery. Under the diagnosis of myocardial infarction complicating myocardial abscess, debridement of abscess and coronary artery bypass grafting with right internal mammary artery to distal right coronary artery was performed. Culture from the abscess cavity demonstrated Salmonella arizona.