• Journal of Chest Surgery
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• v.36 no.12
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• pp.995-998
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• 2003

During coronary artery bypass surgery, there are several discrete maneuvers that facilitates localization of the invisible left anterior descending coronary artery. In some cases with intramyocardial left anterior descending artery, long-term patency of a bypassed graft may depend on anastomosing the internal mammary artery graft to the more proximal and superficial site of the intramyocardial left anterior descending artery. We describe an easy technique to locate the proximal superficial left anterior descending artery with a distal coronary arteriotomy and retrograde insertion of a coronary probe.

• Journal of Medicine and Life Science
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• v.20 no.3
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• pp.131-134
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• 2023

Here, we present a case of a 56-year-old man with acute myocardial infarction. The patient underwent percutaneous coronary intervention (PCI) at the left main bifurcation and mid-left anterior descending artery using drugeluting stents. Four months after the PCI, the patient was readmitted for cardiac arrest. Coronary angiography (CAG) revealed stent thrombosis in the left main-to-proximal left anterior descending artery and in-stent restenosis in the left main-to-proximal left circumflex artery. We performed balloon angioplasty at the left main to mid-left anterior descending artery and left main to proximal left circumflex artery stents; subsequently, blood flow was fully restored. However, contrast agent extravasation was observed outside the mid-portion of the left main artery to the proximal left anterior descending artery stent, indicating the presence of a coronary artery aneurysm (CAA) outside the stent. After guideline-directed medical therapy with dual antiplatelet agents and high-intensity statins, follow-up CAG revealed near-resolution of the CAA, absence of stenotic lesions, and good blood flow.

• Journal of Chest Surgery
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• v.13 no.2
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• pp.125-129
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• 1980

A patient with anomalous coronary artery crossing right ventricular outflow tract in association with Tetralogy of Fallot underwent total correction. The left anterior descending coronary artery was originated from right coronary artery anterior to the pulmonary valve ring. The incision from outflow tract to pulmonary artery tunneled underneath the aberrant artery and patch graft across the pulmonary valve ring to enlarge outflow of right ventricle and stenotic pulmonary valve ring.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.307-314
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• 1992

The internal mammary artery has been advocated for use in bypass grafting owing to its superior long-term patency when compared to saphenous vein grafts. Concern exists that the flow through internal mammary artery may be inadequate during periods of peak myocardial demand when the internal mammary artery graft was used for proximal left anterior descending artery stenosis. This flow adequacy was investigated in 13 consecutive patients with a mean proximal left anterior descending artery stenosis of 84.2% who were selected for coronary bypass using internal mammary artery. We checked flow and diameter of left internal mammary artery without intraluminal dilatation just before anastomosis to left anterior descending artery during cardiopulmonary bypass. Clinical results were evaluated postoperatively with clinical symptoms, echocardiographies, stress tests, and coronary angiographies. The mean internal mammary artery flow measured just before anastomosis was 38ml/ min[range of 20 to 80ml /min] and its mean internal diameter 1.4mm. Maximal workload was improved from preoperative value of 6.3$\pm$2.5METS to postoperative value of 9.1$\pm$1.4 METS in 9 patients who Paired-test can be used. Cardiac symptoms recurred in two patients after bypass surgery, but they were not related to left internal mammary artery grafts. All patients were discharged in postoperatively 9.3 days[range of 7 to 20 days] after operation without mortality. Thus, on the basis of these findings, the internal mammary artery is a reasonable graft that we can routinely use for proximal left descending artery stenosis if internal diameter of the internal mammary artery is more than 1.0mm and its flow is more than 20ml /min at mean arterial pressure of 50 to 60mmHg during cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.21 no.5
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• pp.842-849
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• 1988

Between July, 1987, and September, 1988, 6 patients with coronary occlusive disease received coronary artery bypass surgery at Kyungpook University Hospital. There were five males and one female whose age ranged from 39 to 64 years[mean 54*8.0 years]. Of the 6 patients, 5 suffered from unstable angina, 1 suffered from stable angina. Selective coronary angiography revealed a significant stenosis of the left anterior descending artery in 6 cases, of its diagonal branch in 1 case, of the right coronary artery in 1 case, the circumflex artery in 1 case, and of its obtuse marginal branch in 1 case. The mode of anastomosis were single saphenous vein graft in 3 cases, single left internal mammary artery graft in 1 case, double saphenous vein graft with sequential anastomosis in 1 case, and left internal mammary artery plus saphenous vein graft in 1 case. Of these, 6 grafts to left anterior descending artery were done. There was no operative death, but perioperative myocardial infarction was happened in 1 case. All survivors were free of angina and discontinuing medical therapy during the follow up period[mean 7.8*5.15 months].

• Journal of Chest Surgery
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• v.18 no.2
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• pp.214-219
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• 1985

It is well known that the morphologic feature of coronary artery is variant as finger print. Left coronary artery is divided into the left anterior descending artery and circumflex artery and supplies almost left atrium, left ventricle and interventricular septum. Clinically, the morphologic features of number of branches and the length of the left main coronary artery are important. In Korea, there are few reports about morphologic study of the coronary artery, and the coronary angiogram and open heart surgery are common. Now the author studied the morphology of the proximal part of the left coronary artery in Korean 50 Adult cadavers and obtained the following results: 1. The length of the left main coronary artery is from 5 mm to 16 mm [mean 9.7 mm]. 2. The diameter of the proximal part of the left coronary artery is from 3.2 mm to 7.7 mm [mean 5.3]. 3. The features of the branching are bifurcation [58%] trifurcation [38%] and quadrifurcation [4%]. 4. The diameter of the left anterior descending artery is from 2.7 mm to 8.1 mm [mean 4.5] and circumflex artery from 2.1 mm to 6.2 mm [mean 3.9].

• Journal of Chest Surgery
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• v.33 no.2
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• pp.167-172
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• 2000

Background: As the internal mammary artery is far superior to the vein in the patency rate recently there has been a tendency to use the arterial graft as much as possible in coronary artery bypass grafts with the expectation of better the short- and long-term patency rate. Material and Method: We sequentially grafted the diagonal and the left anterior descending artery significantly influencing the cardiac function with the internal mammary artery. There were 32 cases of sequential grafts from July 1993 to December 1998: 21 men and 11 women. The age range was from 43 to 69 years with a mean age of 56.64$\pm$6.41 years. There were 22 unstable angina 7 stable angina and 3 acute myocardial infarction. 8 cases of them were accompanied by stenosis of the left main coronary artery. The grafts for coronary artery bypass surgery included the great saphenous vein at 60 the right gastroepiploci artery at 5 and the left internal mammary artery at 64 coronary arteries. Result: One patient died from sepsis and multiorgan failure. Complications included wound infections in two cases and gastrointestinal bleeding in one patient. All patients showed decrease or disappearance of angina after operation. The postoperative coronary angiogram performed in 9 patients showed neither occlusion nor stenosis of the grafts. Conclusion: This study suggests that sequential anastomosis of the internal mammary artery to the diagonal and the left anterior descending artery may result in excellent short-term patency diagonal and the left anterior descending artery may result in excellent short-term patency rate and be useful for the coronary artery bypass graft using only arterial grafts

• Journal of Chest Surgery
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• v.32 no.10
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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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• v.20 no.1
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• pp.202-208
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• 1987

Congenital coronary artery fistula is a rare condition, and with widespread use of cardiac catheterization, angiography and selective coronary arteriography are being recognized with increasing frequency. Fistula originating from the right coronary artery are more common then those from the left coronary artery. The fistula empties into the right side of the heart in 90% of the cases with the right ventricle being the most common recipient chamber followed by the right atrium and the pulmonary artery. Recently we experienced two cases of congenital coronary artery fistula which originated from the left coronary artery each other. The first case was 17 moth-old-male, who have had the symptoms of frequent URI, dyspnea and continuous murmur in physical examination. The fistulous communication was noted between the left circumflex coronary artery and the right ventricle with aneurysmal dilation of RV wall. The proximal opening of the fistulous tract was directly close with partial aneurysmorrhaphy of RV wall. Also the termination site of fistulous tract in RV chamber was closed. The second case was 35-year-old female, who have had the symptom of exertional dyspnea and continuous murmur in physical examination. The tortuous and dilated fistulous tract was noted between the left anterior descending coronary artery and the pulmonary artery. The proximal opening of the fistula was ligated near the left anterior descending coronary artery with preservation of normal continuity of coronary artery. And the dilated tortuous vessel was excised. Also the terminal site in pulmonary artery was directly closed just above the pulmonic valve. Postoperative hospital courses of two patients were uneventful without any specific complications and discharged without problems.

• Journal of the Korean Society of Radiology
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• v.85 no.2
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• pp.428-433
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• 2024

Dual left anterior descending artery (LAD) is a rare congenital coronary artery anomaly with a prevalence of approximately 1% in the general population. To date, 10 types of dual LAD artery anomalies have been reported. Among these, type 4 is one of the rarest. Knowledge and recognition of the dual LAD artery are important for correct diagnosis and planning of coronary bypass surgery and percutaneous coronary intervention. We report a case of a 59-year-old male with type 4 dual LAD artery who presented with dyspepsia and sweating for several months and had approximately 50%-70% stenosis in a major diagonal branch off the short LAD artery.