• Journal of Chest Surgery
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• 제50권2호
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• pp.105-109
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• 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
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• 제36권5호
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• pp.303-308
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• 2003

배경: 관상동맥우회술 시 이용하는 내흉동맥은 그 장기 개통률이 다른 도판보다 우수하다고 알려져 있다. 또한 양측 내흉동맥을 이용하면 좋은 개통률로 보다 많은 관상동맥에 접근할 수 있다. 그러나 양측 내흥동맥의 박리로 수술조기 합병증이 증가할 것이라는 관점이 있어 보고자가 경험한 수술 조기결과를 보고하고자 한다. 대상 및 방법: 2001년 7월부터 2002년 5월까지 양측 내흉동맥을 이용하여 관상동맥우회술을 시행한 26예를 대상으로 하였다. 대상환자 중 당뇨병을 가진 8예와 당뇨병이 없는 18예를 비교하여 수술결과를 분석하였다. 또한 같은 기간에 단측 내흉맥을 이용하여 수술한 20예를 대상 환자군과 비교하여 그 수술결과를 분석하였다. 결과: 수술사망은 없었다. 수술 후 합병증은 창상감염으로 당뇨군과 정상군 각각 1예가 있었다. 당뇨군과 정상군 간에는 수술시간, 기관삽관시간, 출혈량, 강심제투여시간, 그리고 합병증 발생에서는 서로 차이가 없었다. 단측 내흉동맥군과 수술결과에 있어 차이가 없었다. 결론: 양측 내흉동맥을 이용한 관상동맥우회술의 수술 조기결과는 단측 내흉동맥을 이용한 수술결과와 차이가 없었고 양측 내흉동맥을 이용한 환자 중 당뇨병이 있는 경우에도 정상군과 수술결과의 차이는 없었다. 당뇨병 환자에 있어 양측 내흉동맥의 이용은 고려할 만하다고 생각한다.

• Journal of Chest Surgery
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• 제32권10호
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• pp.897-902
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• 1999

Use of the left internal thoracic artery(ITA) to bypass the left anterior descending(LAD) coronary artery has become the standard of care based on its superior graft patency, reduced cardiac events, and enhanced survival. But rarely we encountered with injury to the artery during harvesting which leads to loss of the merits of surgery. We reconstructed inadequate ITAa with other arterial conduits so proximal stump to be a blood source if possible. Maternal and method: Between January 1996 and March 1999, 12 patients received bypass with the reconstructed left internal thoracic artery grafts to left anterior descending artery because of an injury(n=8), short or small(n=4). Right or left ITA was used to LAD as a free graft(n=2). And the other 10 left ITAs were extended with radial artery(n=6), right ITA(n=3), saphenous vein(n=1). Composite "T" graft was made with other arterial conduits in these extended graft(n=5). Result: There was only one morbidity of minor would problem, and no mortality. The patency of extended graft to LAD was complete in 5 patients who received angiography during the period of 2wks to 2 years postoperative, but one of side branch of "T" graft occluded. All of these patients were well. Conclusion: Reconstructive extension with the use of other arterial conduit for the injured proximal ITA is warranted in any patients with acceptable results. acceptable results.

• Journal of Chest Surgery
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• 제32권10호
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• pp.891-896
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• 1999

Increasing interest in the use of arterial conduites is based on the better patency of the internal thoracic artery(ITA) than the saphenous vein graft and the hope that other arterial conuits will perform similarly over the long term. Material and Method: Between May 1997 and July 1998, 43 patients underwent coronary artery bypass grafting with ITA and the radial artery(RA). There were 28 men and 15 women with a mean age of 61.5 years(range, 35 to 78). In 43 patents, 30 bilateral ITA(including 7 diabetes mellitus, 5 more older 70 years), 8 bilateral ITA only, 2 left ITA and both RA, 11 left ITA and left RA and 22 both ITA and left RA were used. Result: There was 1 hospital mortality. Of the 42 patients alive, 39 patients are asymptomatic. Postoperative complications were postoperative bleeding in 1 patients, and low cardiac output syndrome in 3. Follow-up angiography was performed in 5 patients after the operation(mean 3 months), and all ITA & RA grafts showed excellent results. Conclusion: We conclude that complete arterial revascularization with internal thoracic artery and radial artery is technically feasiale with low mortality and morbidity, and but long term follow-up is needed.

• Journal of Chest Surgery
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• 제47권5호
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• pp.465-467
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• 2014

We present a patient who developed recurrent angina after coronary artery bypass grafting (CABG). Myocardial single-photon emission computed tomography (SPECT) demonstrated deterioration in the myocardial perfusion, and coronary angiography revealed an overgrown side branch of the grafted left internal thoracic artery (ITA); otherwise, there were no significant changes compared with previous imaging studies obtained after the CABG. After percutaneous embolization of the grafted left ITA side branch, the angina was resolved and myocardial SPECT showed improved perfusion.

• Journal of Chest Surgery
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• 제32권7호
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• pp.690-692
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• 1999

내흉동맥의 골격화된 이식편은 많은 장점을 가지고있기 때문에 관상동맥우회술에 통상적으로 이용되고 있다. 그러나 그 이식편은 가늘고 연약하기 때문에 쉽게 위치가 바꾸어질 수 있고 손상 받을 수 있다. 심막- 흉선 사이에 통로를 만들어 골격화된 내흉동맥이 안정된 최단경로에 놓이도록 하는 간단한 수술방법을 소개한다.

• Tuberculosis and Respiratory Diseases
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• 제68권2호
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• pp.101-104
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• 2010

Bronchopulmonary sequestration (BPS) is a rare congenital malformation of the lower respiratory tract. Most intralobar BPSs are provided with an arterial blood via the thoracic or abdominal aorta but such a supply is rarely found in patients older than 50 years. We report a case of an intralobar BPS with a dual arterial supply from the celiac artery and thoracic aorta in a 50-year-old man presenting with a respiratory tract infection and haemoptysis. To our knowledge, this is the first case report of a BPS supplied by the celiac artery and thoracic aorta in a 50-year-old man.

• Journal of Chest Surgery
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• 제37권10호
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• pp.839-844
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• 2004

배경 및 목적: 속가슴동맥 편과 유리 노동맥 편의 Y-복합이식편은 관상동맥우회 술에 많이 이용된다. 이 연구의 목적은 속가슴동맥 편의 혈류를 증가시킬 수 있는 방법을 찾고 Y-복합이식편의 혈류역학을 알고자 함이다. 대상 및 방법: 관상동맥우회 술을 받은 15예에서 속가슴동맥 편을 두 가지 방법으로 처치하여 속가슴동맥 혈류량을 측정하였다. 7예에서는 혈관 외부에만 파파베린 액을 처치하였고 8예에서는 혈관 내로 파파베린 액을 주입하였다. 다른 18예에서는 속가슴동맥 편과 유리 노동맥 편으로 Y-복합이식편을 만들어 사용하였고 그 자유 혈류량과 두 분지의 혈류 변화를 조사하였다. 결과: 속가슴동맥 편의 혈관 내로 파파베린을 주사한 경우는 혈관외부에 파파베린을 처치한 경우보다 약 2배의 자유혈류량을 얻을 수 있었다(47.7$\pm$9.6 mL/min와 100.8$\pm$26.3 mL/min, p<0.001). Y-복합이식편의 양측을 다 연 상태에서 총 자유혈류량은 속가슴동맥 측만을 열었을 때나 노동맥 측만을 열었을 경우보다 훨씬 많았다(173.3$\pm$45.3 mL/min와 121.1$\pm$34.3 mL/min 혹은 117.5$\pm$42.8 mL/min, 각각 p<0.001). Y-복합이식편의 양 분지를 다 연 경우 양측의 혈류량은 차이가 없었다(85.4$\pm$27.8 mL/min와 87.9$\pm$42.4 mL/min, p=0.772). Y-복합이식편에서 한 측의 혈류량은 다른 측을 열 때보다 막을 때 훨씬 많았다. 결론: 속가슴동맥 편의 혈관 내에 파파베린 액을 주입하는 방법은 자유혈류량을 올릴 수 있는 매우 효과적인 방법이다. 속가슴동맥 편과 유리 노동맥 편의 Y-복합이식편은 속가슴동맥의 단독이식편보다 더 많은 자유혈류량을 보이며, Y-복합이식편의 한 측의 혈류량은 다른 측의 혈류량의 변화에 따라 변할 수 있다.

• Journal of Chest Surgery
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• 제48권4호
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• pp.285-288
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• 2015

In coronary artery bypass grafting, a diffusely diseased left anterior descending coronary artery (LAD) is an obstacle to achieving complete revascularization, consequently leading to the possibility of a poor prognosis. Long segmental reconstruction with or without endarterectomy is a revascularization method for treating diffusely diseased coronary arteries. Herein, we report a successful case of long segmental reconstruction of a diffusely diseased LAD using a left internal thoracic artery onlay patch after endarterectomy.

• Journal of Chest Surgery
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• 제53권2호
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• pp.64-72
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• 2020

Background: It is generally agreed that using a bilateral internal thoracic artery (BITA) composite graft improves long-term survival after coronary artery bypass grafting (CABG). Although the left internal thoracic artery (LITA)-based Y-composite graft is widely adopted, technical or anatomical difficulties necessitate complex configurations. We aimed to investigate whether BITA configuration impacts survival or patency in patients undergoing coronary revascularization. Methods: Between January 2006 and June 2017, 1,161 patients underwent CABG at Seoul National University Bundang Hospital, where the standard technique is a LITA-based Y-composite graft with the right internal thoracic artery (RITA) sequentially anastomosed to non-left anterior descending (LAD) targets. Total of 160 patients underwent CABG using BITA with modifications. Their medical records and imaging data were reviewed retrospectively to investigate technical details, clinical outcomes, and graft patency. Results: Modifications of the typical Y-graft (group 1, n=90), LITA-based I-graft (group 2, n=39), and RITA-based composite graft (group 3, n=31) were used due to insufficient RITA length (47%), problems using LITA (28%), and target vessel anatomy (25%). The overall 30-day mortality rate was 1.9%. Among 116 patients who underwent computed tomography or conventional angiography at a mean interval of 29.9±33.1 months postoperatively, the graft patency rates were 98.7%, 95.3%, and 83.6% for the LAD, left circumflex artery, and right coronary artery territories, respectively. Patency rates for the inflow, secondary, and tertiary grafts were 98.2%, 90.5%, and 80.4%, respectively. The RITA-based graft (group 3) had the lowest patency rate of the various configurations (p<0.011). Conclusion: LITA-based Y composite graft, showed satisfactory clinical outcomes and patency whereas modifications of RITA- based composite graft had the lowest patency and 5-year survival rates. Therefore, when using RITA-based composite graft, other options should be considered before proceeding atypical configurations.