• Journal of Chest Surgery
• /
• v.33 no.1
• /
• pp.38-44
• /
• 2000

Background: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. Material and Method : The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60$\pm$9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. Result: The mean number of grafts was 3.2$\pm$1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13$\pm$20 hours after the operation. Mean duration of stay in intensive care unit was 49$\pm$46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70$\pm$1.36 pack/patient. Conclusion: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.less cost.

• 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.39 no.11 s.268
• /
• pp.815-821
• /
• 2006

Background: Carotid endarterectomy is an effective treatment modality in patients with severe carotid artery stenosis, but it may result in serious postoperative complications, We analyzed the results of the carotid endarterectomy performed in our institution to reduce the complications related to the card endarterectomy. Material and Method: We analyzed retrospectively the medical records of 74 patients(76 cases) who underwent carotid endarterectomy for carotid artery stenosis by a single surgeon from February 1996 to July 2004. Result: There were 64 men and 10 women. The mean age of the patients was 63.6 years old. Carotid endarterectomy only was performed in 63 cases, carotid endarterectomy with patch angioplasty in 8 cases, and carotid endarterectomy with segmental resection of internal carotid artery and end to end anastomosis in 5 cases. Intra-arterial shunt was used in 29 cases. The mean back pressures of internal carotid arteries checked after clamping common carotid arteries and external carotid arteries were $23.48{\pm}10.04$ mmHg in 25 cases with changes in electroencephalography(group A) and $47.16{\pm}16.04$ mmHg in 51 cases without changes in electroencephalography(group B). There was no statistical difference in the mean back pressure of internal carotid arteries between two groups(p=0.095), but the back pressures of internal carotid arteries of all patients with changes in electroencephalography were under 40 mmHg. When there was no ischemic change of electroencephalography after clamping common carotid artery and external carotid artery, we did not make use of intra-arterial shunt regardless of the back pressure of internal carotid artery. Operative complications were transient hypoglossal nerve palsy in four cases, cerebral hemorrhage occurred at previous cerebral infarction site in two cases, mild cerebral infarction in one case, hematoma due to anastomosis site bleeding in one case, and upper airway obstruction due to laryngeal edema probably caused by excessive retraction during operation in two cases. One patient expired due to cerebral hemorrhage occurring at previous cerebral infarction site. Conclusion: Carotid endarterectomy is a safe operative procedure showing low operative mortality. We suggest that intra-arterial shunt usage should be decided according to the ischemic change of electroercephalography regardless of the back pressure of internal carotid artery. Excessive retraction during operation should be avoided to prevent upper alway obstruction due to laryngeal edema and if upper airway obstruction is suspected, prompt management is essential.

• Journal of Chest Surgery
• /
• v.39 no.10 s.267
• /
• pp.779-781
• /
• 2006

Left main coronary artery atresia is a very rare congenital coronary anomaly with blind end of left main trunk. The clinical symptoms as syncope, failure to thrive, and myocardial infarction are presented and surgical treatments are required in most cases. We report a case of a 14-months-old girl with left main coronary artery atresia and excel-lent surgical result of 1 year follow-up after coronary artery bypass with left internal thoracic artery.

• Journal of Chest Surgery
• /
• v.40 no.11
• /
• pp.773-776
• /
• 2007

A 47-year-old male with hypertension, diabetes mellitus and heavy smoking, but no anginal symptoms, presented with claudication of the lower extremities. Extremity angiography with coronary angiography revealed peripheral arterial lesions including a left subclavian artery occlusion with coronary artery disease. The patient underwent an initial off-pump coronary artery bypass with an ascending aorto-axillary bypass. The right internal mammary artery was anastomosed to the left anterior descending coronary artery. The greater saphenous vein graft was connected from the ascending aorto-axillary bypass graft to the diagonal branch. At postoperative day 18, femorofemoral and bilateral femoropopliteal bypasses were performed. We report a case of the combined repair of coronary artery disease and a left subclavian artery occlusion.

• Journal of Chest Surgery
• /
• v.29 no.11
• /
• pp.1263-1266
• /
• 1996

We have experienced a case of coronary artery bypass surgery without extracorporeal circulation through limited anterior thoracotomy. The lesion was a single vessel disease involving the take off of the left anterior descending artery(LAD) which showed tubular lesion with irregular contour and eccentric stenosis of more than 95% luminal narrowing. Percutaneous transluminal coronary angioplasty(PTCA) seemed to have moderate success rate and moderate complication rate. A segment of left internal mammary artery(LIMA) from the second rib down to the sixth rib was harvested through the bed of resected fourth costal cartilage. Anastomosis between LIMA and LAD was performed under beating condition. The patient was extubated in the operation room and showed excellent postoperative course without complications. The coronary angiography on the postoperative 7th day revealed good patency at the anastomosis site.

• Journal of Chest Surgery
• /
• v.46 no.4
• /
• pp.265-273
• /
• 2013

Background: The safety and efficacy of arterial composite grafts for total arterial revascularization have been demonstrated. The saphenous vein (SV) is a widely used graft because of its accessibility, sufficient length, and ease of manipulation. Our aim was to compare mid-term outcomes of saphenous vein Y-grafts with radial artery Y-grafts joined by anastomosis to the left internal thoracic artery. Materials and Methods: Records of off-pump coronary artery bypass grafting with composite Y-grafts based on the left internal thoracic artery technique in 552 patients were analyzed retrospectively. After propensity score matching, 79 radial arterial (RA) composite grafts (RA group) and 79 saphenous vein composite grafts (SV group) were compared. The duration of mean follow-up was $24.6{\pm}14.6$ months (range, 1 to 55 months). Results: There were no differences in surgical mortality, all-cause mortality, or morbidity among the groups. Rates of 4-year survival were 91.7% and 96.3% in the RA and SV groups, respectively (p=0.519). The coronary reintervention-free survival rate and freedom from major adverse cardiovascular or cerebrovascular events were similar in the two groups (p=0.685, p=0.564). Conclusion: Construction of composite Y-grafts using the radial artery or saphenous vein showed similar mid-term results. Long-term follow-up and randomized trials will be needed to confirm our present conclusions.

• Korean Journal of Poultry Science
• /
• v.26 no.1
• /
• pp.27-33
• /
• 1999

The distribution of oviductal vessels of eight Korean native pheasants was observed after Latex casts of vessels. Latex was injected into thoracic aorta and posterior vena cava of these birds for cast preparation. The results were as follows: 1. The arteries suppling oviduct of the Korean native pheasants contained A. oviductalis cranialis, media, caudalis and vaginalis. The veins drainaging oviduct were stretched along the following ateries and all of the oviductal vessels were situated on the left side of the body. 2. The anterior oviductal artery arose from the pubic artery of the left external iliac artery and distributed to the infundibulum and the magnum of the oviduct. 3. The middle oviductal artery arose from the left sciatic artery and distributed to the isthmus and shell gland of the oviduct. 4. The caudal artery arose from the left internal pudendal artery of the median sacral artery and distributed to the caudal part of uterus and the cranial part of vagina. 5. The vaginal artery arose from the left internal pudendal artery of median sacral artery and distributed to the caudal part of vagina.

• Journal of Chest Surgery
• /
• v.32 no.12
• /
• pp.1127-1130
• /
• 1999

Percutaneous coronary intervention including intracoronary stenting is currently an accepted treatment modality in the treatment of coronary artery disease and is widely performed to treat the patient with multivessel disease with decreased morbidities and less cost compared with conventional coronary rtery bypass grafting(CABG), Repeated interventions due to restenosis even after successful angioplasty are the major disadvantage of the angioplsty especially when the lesion is located inthe left anterior descending artery(LAD) Recently CABG through left anterior small thoracotomy using the left internal thoracic artery to revascularize the LAD territory without cardiopulmonary bypass so called Minimally Invasive Direct Coronary Artery Bypass(MIDCAB) was intrduced and performed with comparable early outcomes. In this regard the integrated approach with percutaneous coronary intervention and minimally invasive direct coronary artery bypass surgery so called 'Hybrid CABG' was suggested to be an effective treatment in suitable patients with multivessel coronary artery disease. We report three cases of Hybrid CABG.

• Journal of Chest Surgery
• /
• v.22 no.3
• /
• pp.384-392
• /
• 1989

Forty cases of coronary artery bypass grafting treated at the Department of Thoracic and Cardiovascular Surgery, SNUH, Korea were compared with forty cases of the procedure treated at University of Alberta Hospital, Canada, in terms of pathoanatomy. That showed no difference in sex ratio between Korean and Caucasian the average ages, however, were 50.4 years and 60.9 years respectively [p< 0.005]. The leading cause of angina at presentation was unstable angina in Korean, but it was post-infarction angina in Caucasian instead. The incidences of single-vessel disease and double-vessel disease were similar in both countries, but the incidence of so-called triple-vessel disease was higher in Caucasian while left main coronary artery disease was more prevalent in Korean [0.01< P, 0.005]. < The internal diameters of surgically available coronary artery branches had similar characteristics and no significant statistical differences were found between them. The predilection sites of stenoses were proximal left anterior descending artery, left main coronary artery, proximal left circumflex artery and proximal right coronary artery decreasing in incidence respectively, in Korean. The myocardial perfusion score were 6.80 in single-vessel disease, 7.56 in double-vessel disease, 11.27 in triple-vessel disease and 9.77 in left main disease respectively, in Korean.