• Journal of Chest Surgery
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• v.33 no.7
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• pp.576-580
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• 2000

Transmycardial laser revascularization has made its position as a sole therapy for patients with chronic angina nonamenable to maximal medical therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting. We report three cases of transmyocardial laser revascularization as a sole therapy for patients with recurrent angina after CABG.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.1
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• pp.8-16
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• 2008

Purpose: To assess the effect of extracranial-intracranial (EC-IC) bypass surgery on hemodynamic improvement, we evaluated serial regional cerebral hemodynamic change of the middle cerebral artery (MCA) in symptomatic patients with atherosclerotic occlusion of the internal carotid artery (ICA) or MCA using $^{99m}Tc$-ECD acetazolamide stress brain perfusion SPECT (Acetazolamide SPECT). Materials and Methods: The patients who had suffered a recent stroke with atherosclerotic ICA or MCA occlusion underwent EC-IC bypass surgery and Acetazolamide SPECT at 1 week before and three to six months after surgery. For image analysis, attenuation corrected images were spatially normalized to SPECT templates with SPM2. Anatomical automated labeling was applied to calculate mean counts of each Volume-Of-Interest (VOI). Seven VOIs of bilateral frontal, parietal, temporal regions of the MCA territory and the ipsilateral cerebellum were defined. Using mean counts of 7 VOIs, cerebral perfusion index and perfusion reserve index were calculated. Results: Seventeen patients (M:F =12:5, mean age $53{\pm}2yr$) were finally included in the analysis. The cerebral blood flow of the parietal region increased at 1 week (p = 0.003) and decreased to the preoperative level at 3-6 months (p = 0.003). The cerebrovascular reserve of the frontal and parietal regions increased significantly at 1 week after surgery (p<0.01) and improved further at 3-6 months. Conclusion: Cerebrovascular reserve of the MCA territory was significantly improved at early postoperative period after EC-IC bypass and kept improved state during long-term follow-up, although cerebral blood flow did not significantly improved. Therefore, cerebrovascular reserve may be a good indicator of postoperative hemodynamic improvement resulted from bypass effect.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.260-263
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• 2008

We performed three cases of extraanatomic bypass graft for treating adult coarctation. Two cases of left subclavian artery to descending aorta bypass graft were done via left thoracotomy for treating 2 patients who had extensive aortic occlusive disease. One case of ascending aorta to descending aorta bypass graft and aortic valve replacement was done via median sternotomy for a patient who had combined arch hypoplasia and aortic valve regurgitation. One patient was reoperated on for aneurysm rupture of an anastomosis site four months after the first operation and two patients have had no specific problems during and after their operations.

• 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.37 no.9
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• pp.762-767
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• 2004

With the developement of non-invasive surgical techeniques, coronary artery bypass graft without cardiopulmonary bypass has become popular. We compared the preoperative risk factors and in-hospital outcomes of patients having off-pump CABG with these having on-pump CABG. Material and Method： From January 2001 to June 2003, 87 patients underwent CABG. Thirty-sin patients underwent on-pump CABG, fifty-one patients under-went off-pump CABG. Preoperative risk factors, extent of coronary disease, operative time, postoperative endotracheal intubation time, duration of ICU stay & hospital stay, the amount of bleeding and postoperative levels of cardiac enzymes were compared in both groups, Result: The were no differences in their sex ratios, ages, preoperative risk factors, preoperative Ml, Canadian classes, extent of coronary artery diseases and, echocardio-graphic ejection fraction between Off-pump CABG and On-pump CABG groups. Off-pump CABG group had significantly lower mean operative time (270$\pm$79.3 min vs 372$\pm$142.2 min, p＜0.001), mean ventilation time (17.1$\pm$13.4 hr vs 24.3$\pm$17.8 hr) and CK-MB level (8,9$\pm$18.7 IU/L vs 25.7$\pm$8.4 IU/L) than on-pump CABG groups, On-pump CABG group had more distal grafts (2.2$\pm$0.5 vs 1.7$\pm$0.71 than Off-pump CABG groups did. There were no differences in their postoperative complications and outcomes including amount of postoperative bleeding for 24 hrs, reoperation for bleeding control, mean in-hospital days, postoperative infection, renal failure and neurologic complications between Off-pump CABG and On-pump CABG groups. Conclusion: This study showed that patients who underwent Off-pump CABG had less operation time & intubation time and lower CK-MB level; however, they also have less distal graft. Even though CABG without CPB provided satisfactory results, more clinical experience & longer follow-up is required.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.508-511
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• 2008

The incidence of the Buerger's disease is higher for the far-East Asian population that for western people, but the surgical outcomes have been documented to be unsatisfactory. So, more aggressive and multi-focused treatment modalities should be warranted such as stopping smoking or intravenous vasodilator infusion with surgery. We report here on a successful surgical case of intra-arterial direct infusion of Prostaglandin E1 concomitant with surgical bypass and lumbar sympathectomy to treat Buerger's disease.

• Proceedings of the KTCVS Conference
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• 1998.10a
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• pp.181-181
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• 1998

• Journal of Chest Surgery
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• v.34 no.6
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• pp.499-501
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• 2001

In the 1970s, the radial artery was proposed as a coronary artery bypass graft but then was abandoned due to graft occlusion secondary to spasm during harvesting. Development of new pharmacologic antispasmodic agents and minimal traumatic harvesting techniques has led to the revival of the use of the radial artery in coronary artery bypass procedures. Harmonic Scalpel(Ultracision Inc, Smithfield, Rl) offers the surgeon the ability to perform less traumatic, spasm free, and rapid radial artery harvesting.

• Transactions of the Korean Society of Mechanical Engineers B
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• v.36 no.2
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• pp.153-159
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• 2012

Bypass anastomosis is frequently adopted for surgical treatments of stenosed coronary arteries. Optimal coronary bypass grafting should be investigated to improve the patency in arterial bypass techniques. The objective of this study is to analyze the effects of Y-grafting bypasses and T-grafting bypasses for various bifurcation and anastomotic angles. In order to find the optimal geometric configuration, the hemodynamic characteristics are obtained and compared with each other for different geometries. We found that both the left anterior descending artery (LAD) and left circumflex artery (LCX) blood flows were distributed evenly when the bypass grafting angle and bifurcated angle were $30^{\circ}$ and $15^{\circ}$, respectively,.

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.749-753
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• 2006

Background: The purpose of this study is to assess a score system for operative risk evaluation of CABG. Material and Method: From January 2001 to September 2005, retrospective study for various perioperative factors of 2993 cases was done. Result: The early operative mortality was 2.4% and the beta coefficients of 7 core variables related to it (preoperative LV dysfuction, preoperative renal failure, MI within 1 week, reoperation, combined surgery, preoperative atrial fibrillation, preoperative IABP) were adjusted to score system. ROC curve and Hosmer and Lemeshow goodness of fit test was done. Conclusion: This score system was effective in assessing operative risk of CABG. But It is necessary to gather larger volume of case and perform multicenter study.