• 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.21 no.3
• /
• pp.583-587
• /
• 1988

Bilateral coronary artery-pulmonary artery fistula is very uncommon congenital heart disease which occupy small percentage of all coronary arterio-venous fistulas. We experienced a case who was 52 years old female with bilateral coronary artery-pulmonary artery fistula. She complained exertional dyspnea k angina[coronary steal syndrome]. On physical examination, any cardiac murmur was not audible. There was no 0y step-up in right heart catheterization. But selective coronary angiography revealed tortuous aberrant vessels which originated from the canal branch of the right coronary artery k the left anterior descending coronary artery. Both aberrant vessels traversed the right ventricular outflow tract, and conjoined just proximal the pulmonic annulus and drained into the main pulmonary artery. The operation was performed under the extracorporeal circulation with beating heart. The procedures were suture-ligation of the draining orifice in main pulmonary artery & the feeding vessels on the right ventricular outflow tract. Postoperatively her complaints were completely disappeared and the selective coronary angiography revealed no left-to-right shunt.

• Journal of IKEEE
• /
• v.23 no.2
• /
• pp.557-570
• /
• 2019

In this study, a novel hierarchical approach is investigated to extract coronary vessel from X-ray angiogram. First, we propose to combine Decimation-free Directional Filter Bank (DDFB) and Homographic Filtering (HF) in order to enhance X-ray coronary angiographic image for segmentation purposes. Because the blood vessel ensures that blood flows in only one direction on vessel branch, the DDFB filter is suitable to be used to enhance the vessels at different orientations and radius. In the combination with HF filter, our method can simultaneously normalize the brightness across the image and increases contrast. Next, a coarse-to-fine strategy for iterative segmentation based on Otsu algorithm is applied to extract the main coronary vessels in different sizes. Furthermore, we also propose a new approach to segment very small vessels. Specifically, based on information of the main extracted vessels, we introduce a new method to extract junctions on the vascular tree and level of nodes on the tree. Then, the window based segmentation is applied to locate and extract the small vessels. Experimental results on our coronary X-ray angiography dataset demonstrate that the proposed approach can outperform standard method and attain the accuracy of 71.34%.

• The Korean Journal of Physiology
• /
• v.23 no.2
• /
• pp.225-236
• /
• 1989

1) At the isolated perfused guinea-pig and rat heart heterometric autoregulation of the myocardium and myogenic autoregulation of the coronary vessels were induced by means of stepwise increases of perfusion pressure. 2) According to this loading test Frank-Starling function curves of the left ventricle and pressure-flow curves of the coronary vessels can be drawn. This graphic evaluation gives more information about the condition of the heart and the coronary vessels than simple evaluation under hemodynamic equilibrium. 3) There are significant differences in both curves between animal species and between different perfusate Mg concentration. 4) Myogenic autoregulation is not affected by the cyclooxygenase inhibitors indometacin and me- clofenamate. Thus it appears unlikely that prostanoides are involved in myogenic autoregulation. 5) Ca antagonists (Gallopamil, prenylamine) depress myogenic autoregulation dose-dependently. Enhanced myogenic autoregulation, induced by low extracellular magnesium, can be reduced effectively by Gallopamil. 6) Ginsenosides from Panax ginseng as well as the ginsenoside 'Rg' are effective inhibitors of myogenic autoregulation without major negative inotropic effects.

• Journal of the Korea Institute of Information and Communication Engineering
• /
• v.15 no.9
• /
• pp.2013-2018
• /
• 2011

Coronary angioplasty and coronary artery bypass graft, both are for the treatment of myocardial infarction widely used methods. For these procedures, there are especially difficulties in stenosis of blood vessels to diagnose accurately. To remedy this problem, by several researchers by using edge detection to detect stenosis of blood vessels has been studying. However, the results of using these methods vary defend on the vascular structure and the quality of the image. In this study, to improve these problems, the new algorithm is proposed. The proposed algorithm consists of methods to detect bifurcation of blood vessels and its ending point by using multi sampling, threshold and fuzzy algorithm. To evaluate the performance of the proposed algorithm, angiography was used for the different results of the blood vessels of the proposed algorithm, and the result was effective in detecting bifurcation of blood vessels and its ending point.

• Journal of Chest Surgery
• /
• v.18 no.2
• /
• pp.220-231
• /
• 1985

In selected patients with occlusive lesions of coronary arteries, aortocoronary bypass grafting has been effective in reducing anginal symptoms and in increasing the patients` longevity. Between May, 1977, and December, 1983, 41 patients with coronary occlusive disease received aortocoronary bypass surgery at Yonsei University Medical Center in Seoul. Thirty-three were male and 8 were female. Their ages ranged from 33 to 70 years [average 531.6 years]. Of the 41 patients, 11 suffered from stable angina, 30 suffered from unstable angina and 4 suffered from a variant type of angina. Eleven patients had 1 diseased vessel, 11 patients had 2 diseased vessels, 19 patients had 3 diseased vessels, and 5 patients had a diseased left main coronary artery. A single graft was placed in 5 patients, a double graft was placed in 17 patients, a triple graft was placed in 11 patients and a quadruple graft was placed in 8 patients. Nineteen patients received a sequential graft [40 sites of 20 vessels]. The average internal diameter of the grafted distal coronary artery was 2.380.15, 1.630.13 mm on the left side and 3.200.20, 1.830.21 mm on the right side. Two operative deaths occurred in the early years of our experience. The mortality rate was 4.87% and there were no late deaths. Of the 39 survivors, 30 [76.9%] were Functional Class I [free of symptoms without medication], 7 [17.9%] were Functional Class II and only 2[5.2%] were Functional Class III during the follow up period [653.75 patient-months]. On the basis of this experience, we conclude that coronary artery occlusive disease is occurring in increasing numbers in Korea. Therefore, a concerted effort is needed to detect this disease and to manage the increasing number of patients suffering from it.

• Journal of Chest Surgery
• /
• v.57 no.2
• /
• pp.220-224
• /
• 2024

A coronary artery fistula (CAF) is an abnormal vascular connection between the coronary arteries and the cardiac chambers or major vessels. Although rare, CAFs can lead to substantial coronary morbidity and mortality. This study outlines the surgical management of a CAF originating from the left coronary artery and connecting to the right atrium, in a patient experiencing angina with a marked left-to-right shunt. The surgical approach involved ligation of the coronary artery and reduction of the aneurysmal portion, resulting in the patient's uneventful recovery.

• Journal of Chest Surgery
• /
• v.21 no.3
• /
• pp.553-557
• /
• 1988

Anomalous origin of right coronary artery from pulmonary artery is a rare congenital cardiac anomaly. Anomalous right coronary artery often be a incidental finding without serious cardiovascular sequale. The only characteristic physical finding is a continuous murmur with diastolic accentuation. There are no diagnostic EKG or chest X-ray changes. Diagnosis is made best by selective left coronary arteriography showing retrograde filling of right coronary artery from collateral vessels. Here, we present a case of twenty-four months old aged girl with anomalous origin of right coronary artery combined with pulmonary stenosis. This is the first pediatric patient with anomalous right coronary artery and the first patient to have surgical correction for this malformation.

• Journal of Chest Surgery
• /
• v.21 no.5
• /
• pp.877-881
• /
• 1988

A coronary arteriovenous fistula represents an abnormal communication from a coronary artery that may enter any cardiac chamber, a pulmonary artery, the coronary sinus, the superior vena cava or the pulmonary vein. We had a successful experience with 46 year-old male who complained exertional dyspnea[NYHA classification II] and anginal pain since 5 years ago. In intensive study of cardiac catheterization and coronary cineangiography, multiple bilateral coronary arteriovenous fistulas and mitral stenoinsufficiency with left atrial thrombi were recognized. The coronary arterio-venous fistula of left coronary artery was revealed large tortuous aberrant vessels that were connected between just distal portion of first diagonal branch of left anterior descending artery and main pulmonary artery. Other fistula was small tortuous vessel which was originated from left atrial branch of left circumflex artery, was drained into left atrium. The fistula of right coronary artery was communicated conal branch of right coronary artery to main pulmonary artery. But there was no 0y step-up in the right cardiac catheterization. The operative procedure were suture-ligation of draining orifice of coronary arteriovenous fistula in main pulmonary artery, mitral valve replacement[Ionescu-Shiley 25mm] with removal of left atrial thrombi and plication of left atrium under the extracorporeal circulation. The postoperative course was uneventful without any complication and discharged without problem at 17th postoperative days.

• Journal of Chest Surgery
• /
• v.54 no.2
• /
• pp.146-149
• /
• 2021

Coronary artery bypass grafting (CABG) is rarely performed in infants because of its technical difficulty and unclear long-term results. A 90-day-old male infant weighing 3.5 kg who underwent an arterial switch operation (ASO) for transposition of the great arteries developed left coronary artery insufficiency despite augmentation and reimplantation of the left coronary button. On-pump beating heart CABG was performed using an internal mammary artery graft to revascularize the left anterior descending artery. Postoperative computed tomography angiography revealed that the graft was patent. At 7 months postoperatively, the patient weighed 8.5 kg, and echocardiography revealed good ventricular function. CABG can be an alternative treatment for post-ASO coronary complications in early infancy.