• Journal of Chest Surgery
• /
• v.26 no.2
• /
• pp.148-153
• /
• 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
• /
• v.50 no.2
• /
• pp.105-109
• /
• 2017

Coronary arterial involvement in Takayasu arteritis (TA) is not uncommon. Herein, we describe a case of TA with celiac trunk and superior mesenteric artery occlusion combined with coronary artery disease. Bilateral huge internal thoracic arteries (ITAs) and the inferior mesenteric artery provided the major visceral collateral circulation. After percutaneous intervention to the right coronary artery, off-pump coronary artery bypass grafting for the left coronary territory was done using a right ITA graft and its large side branch because of its relatively minor contribution to the visceral collateral circulation.

• Journal of Chest Surgery
• /
• v.32 no.10
• /
• pp.943-946
• /
• 1999

There was no significant difference in morbidity and mortality between those that received simultaneous operation for coronary artery disease and peripheral vascular disease versus those that received coronary artery bypass graft alone. Simultaneous operation is also cost effective. A 46 year-old patient with resting chest pain and intermittent claudication was diagnosed as unstable angina and Leriche's syndrome. We performed simultaneous revascularization for coronary artery stenosis with internal mammary artery and right gastroepiploic artery and a bifurcated vascular graft interposition between in the aorta, left common iliac and right femoral arteries for Leriche's syndrome. The postoperative coronary angiogram and aortogram revealed a good patency of the arterial conduits and vascular graft. He has been followed for 12 months without any problem.

• Journal of Chest Surgery
• /
• v.48 no.1
• /
• pp.13-24
• /
• 2015

Background: Controversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE. Methods: This study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After follow-up at $9.66{\pm}3.65$ months post-surgery, 28 patients from the CE+ group underwent angiography to evaluate the patency of grafts and native coronary vessels. Results: Patients in the CE+ group had a more prevalent history of diabetes (48% vs. 36%) and number of diseased vessels ($2.88{\pm}0.39$ vs. $2.70{\pm}0.85$). The overall hospital mortality was 1.8%, and no significant difference was observed between the two groups. In the 28 patients who underwent reangiography, 113 vessels were bypassed and 29 endarterectomies were performed, mostly on the left anterior descending artery (12 endarterectomies) and the right coronary artery (8 endarterectomies). In the endarterectomized vessels, a 66% patency rate was found in both the grafts and the native vessels. The native coronary vessels were more likely to be patent when the left internal mammary artery was used as a conduit than when a saphenous vein bypass graft was used. Conclusion: The lack of a significant difference in postoperative complications in patients who underwent CABG with or without CE may indicate that CE does not expose patients to a higher risk of complications. Since most of the endarterectomized vessels were shown to be patent during the follow-up period, we propose that endarterectomy is a viable option for patients with severely diseased vessels.

• Journal of Chest Surgery
• /
• v.26 no.5
• /
• pp.349-354
• /
• 1993

From July 1992 through January 1993, 11 patients with unstable angina received aorto-coronary bypass surgery at Dong-A University Hospital. There were 5 males and 6 females whose age ranged from 36 to 76 years old. Of the 11 patients, 3 were Functional class IL 5 were Functional class 111.3 were Functional class IV. Preoperative coronary angiography showed a significant stenosis of the left anterior descending artery in 9 cases, of its diagonal branch in I case, of the circumfiex artery in 3 cases, and of its obtuse marginal branch in 2 cases, of the right coronary artery in 4 cases, and of left main coronary artery in 3 cases. There were 4 cases of single vessel disease, 1 double vessel disease, 3 triple vessel disease and 3 left main disease. A single graft was placed in 1 patient, a double graft in 5, a triple graft in 2, and a quadriple graft in 3 patients. Left internal mammary artery plus saphenous vein graft were used in 4 patients. Postoperative complications were mediastinitis in 1, sternal instability in 2, pneumonia in 1, arrythmia in I case.

• Journal of Chest Surgery
• /
• v.46 no.1
• /
• pp.84-87
• /
• 2013

A 60-year-old man visited the outpatient clinic due to one month of recurrent exertional chest pain. Eleven years earlier he had undergone off-pump coronary artery bypass grafting using bilateral internal thoracic artery (ITA) Y-composite grafts based on the left ITA. Preoperative coronary angiography showed patent distal graft anastomoses and visualized the left ITA retrogradely. The arch aortography revealed near-total occlusion of the left subclavian artery at the level of the ostium. The patient underwent left carotid-to-subclavian artery bypass grafting using a 6 mm vascular conduit. Postoperative computed tomographic angiography revealed a patent bypass conduit between the left common carotid artery and left subclavian artery. The patient was discharged on postoperative day 4 with no symptoms or signs of myocardial ischemia.

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

• Journal of Chest Surgery
• /
• v.28 no.7
• /
• pp.671-677
• /
• 1995

Skeletonization of the internal mammary artery [IMA during myocardial revascularization procedures may provide some advantages, compared with the pedicle graft of the artery. In 17 patients undergoing IMA grafting by skeletonization technique, flow through the artery was measured on mean arterial pressure of 50-55 mmHg immediately after cardiopulmonary bypass started [first flow and just before its anastomosis to left anterior descending artery [second flow . In 16 patients except 1 patient whose graft was injured during mobilization, the first flow of IMA graft was 32.3 $\pm$ 7.4 ml/min and the second flow increased to 59.6$\pm$25.9 ml/min without any treatment and the site for anastomosis of the IMA graft was more than 1.0 cm above the bifurcation. On the basis of previous clinical studies, the flow of the skeletonized IMA was greater than that of the pedicle graft [59.6 $\pm$ 25.9 ml/min versus 37.7$\pm$ 14.1 ml/min, p < 0.05 . In comparison between the skeletonized IMA and the IMA graft intraluminally dilated with papaverine solution, there was no significant difference between two flows[59.6 $\pm$25.7 ml/min versus 74.7 $\pm$31.4 ml/min, not significant , but the former showed longer graft and anastomosis of more proximal portion of the graft to left anterior descending artery. In conclusion, the technique of internal mammary artery skeletonization has consistently produced a satifactory conduit for myocardial revascularization procedures. We have adopted IMA skeletonization not only because of the flow, diameter, and vessel length obtained but also because of limited perivascular tissue disruption that occurs during the dissection.

• Journal of Chest Surgery
• /
• v.40 no.9
• /
• pp.633-636
• /
• 2007

Coronary artery spasm immediately after the coronary artery bypass graft (CABG) surgery is rare but it can cause sudden and severe hypotension or a ventricular arrhythmia. We report a case of low cardiac output syndrome caused by a right coronary artery spasm following CABG that did not show any significant stenotic lesions on preoperative coronary angiography.

• Journal of Chest Surgery
• /
• v.20 no.2
• /
• pp.384-392
• /
• 1987

The occlusive coronary artery disease presents a potential threat to a significant population in the United State. According to many case reports, the increasing incidence of coronary artery disease due to atherosclerosis is noted in Korean, recently. We experienced one case of coronary artery disease. He was a 68 year old male who had been suffered from hypertension since 1 5 years ago, and had intermittent conservative treatment at local clinic. He had been afflicted with severe chest pain on exertion, but this symptom was relieved on rest. Pre-operative EKG finding revealed no any other ischemic sign. Significant S-T segment depression was noted at lead II, aVF, V3, V4, and V5, and inverted T wave in V5 and V6 after Master`s test. Simple chest X-ray finding showed emphysematous field, bilaterally. Final pre-operative diagnosis was made by coronary angiogram, which showed almost 90% degree of occlusive lesion in the proximal part of left main coronary artery above the origin LAD artery. He was treated successfully by aorta-coronary saphenous vein graft under extra-corporeal circulation in May, 1987. He has been followed up with uneventful course.