• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.359-365
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• 2006

Background: Arterial grafts have been used to achieve better long-term results for coronary revascularization. Bilateral internal thoracic artery (ITA) grafts have a better results, but it may be not used in some situations such as diabetes and chronic obstructive pulmonary disease (COPD). We evaluated the clinical and angiographic results of composite left internal thoracic artery-radial artery (LITA-RA) Y graft. Material and Method: Between April 2002 and September 2004, 119 patients were enrolled in composite Y graft for coronary bypass surgery. The mean age was $62.6{\pm}8.8$ years old and female was 34.5%. Preoperative cardiac risk factors were as follows: hypertension 43.7%, diabetes 33.6%, smoker 41.2%, and hyperlipidemia 22.7%, There were emergency operation (14), cardiogenic shock (6), left ventricle ejection fraction (LVEF) less than 40% (17), and 17 cases of left main disease. Coronary angiography was done in 35 patients before the hospital discharge. Result: The number of distal anastomoses was $3.1{\pm}0.91$ and three patients (2.52%) died during hospital stay. The off-pump coronary artery bypass (OPCAB) was applied to 79 patients (66.4%). The LITA was anastomosed to left anterior descending system except three cases which was to lateral wall. The radial Y grafts were anastomosed to diagonal branches (4), ramus intermedius (21), obtuse marginal branches (109), posterolateral branches (12), and posterior descending coronary artery (8). Postoperative coronary angiography in 35 patients showed excellent patency rates (LITA 100%, and RA 88.5%; 3 RA grafts which anastomosed to coronary arteries <70% stenosed showed string sign with competitive flow). Conclusion: The LITA-RA Y composite graft provided good early clinical and angiographic results in multivessel coronary revascularization. But it should be cautiously used in selected patients.

• The Korean Journal of Nuclear Medicine
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• v.29 no.1
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• pp.31-40
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• 1995

We compared stress/rest myocardial Tc-99m-MIBl tomographic image findings with rest/stress rubidium-82 tomographic images. In 23 patients with coronary artery disease (12 of them received bypass grafts before) and 6 normal subjects, rest rubidium PET study was performed : rubidium-82 and Tc-99m-MIBI were injected simultaneously to each patient after dipyridamole stress for rubidium PET and MIBI SPECT; and rest MIBI SPECT was performed 4 hours thereafter. We scored segmental decrease of rubidium or MIBI uptakes into 5 grades for 29 segments from 3 short-axis, vertical and horizontal slices. Scores were summed for each major arterial territory. When more score than two grade-2's or one grade-3 was considered as the cue for significant stenosis for major arterial territories, 67% of 46 stenosed arteries were found with MIBI studies and 78% of them by rubidium studies. Fourteen among 28 grafted arterial territories of 12 post-CABG patients were found normal with both rubidium and MIBI. Segmental scores were concordant between rubidium and MIBI in 72% of 709 stress segments and in 80% of 825 rest segments. Stress rubidium segmental scores were less than stress MIBI scores in 9%, so were rest rubidium scores. Stress rubidium scores were more than stress MIBI scores in 20% of segments, and rest rubidium segmental scores were more than rest MIBl scores in 11%. Rank correlations (Spearman's rho's more than 0.7(stress) and 0.5(rest), slopes (MIBI/rubidium) around 0.7(stress) and 0.9 (rest)) suggested deeper and wider defects in stress with rubidium. Slope over 1 (MIBI/rubidium) with LAD segemental scores at rest and 7 territories which had much larger score with MIBI revealed exaggeration of rest defects with rest MIBI in same-day stress/rest study. Difference scores (stress-rest for each territory) suggesting Ischemia were larger with rubidium (slope of MIBI/rubidium around 0.45). As has been implied by animal or separate-day-human studies, these segmental analyses with simultaneous examination in patients told that rubidium PET flow studies disclose ischemia more often than MIBI studies and that rest MIBI studies in same-day stress/rest-sequence gave a little larger rest defect than they would have shown.