Successful Coronary Bypass Surgery Research Articles

Successful coronary bypass surgery in a patient with hemophilia: A case report

Successful coronary bypass surgery in a patient with hemophilia: A case report

78. Coronary bypass using bilateral internal mammary arteries in an achondroplast

Coronary bypass grafting for ischemic heart disease in achondroplastic dwarfs is very rare. Shortage of veins and sometimes, inadequate vein quality can cause difficulties during surgery. Only two achondroplastic cases were reported in literature that underwent coronary bypass surgery, in which the left internal mammary artery and vein grafts were used. To the best of our knowledge using bilateral internal mammary arteries in such patients was not reported. We report here a 55 years old male achondroplastic dwarf who had triple vessels coronary disease that underwent successful coronary bypass surgery using bilateral mammary arteries. Anatomic and surgical challenges in achondroplasia are highlighted

Coronary artery bypass grafting without cardiopulmonary bypass: a five-year experience.

The current drive to practice less invasive surgery is changing surgical practice towards safer and simpler procedures. The practice of coronary artery bypass grafting (CABG) on a beating heart without cardiopulmonary bypass (CPB), off-pump CABG or OPCAB, has been gaining great attention as an alternative approach to conventional CABG. Since the first adoption of OPCAB in 1997 at our department, 181 patients have undergone OPCAB. OPCAB was indicated for patients who were possibly at risk for CPB, i.e., those who were elderly, who had a history of cerebrovascular disease, whose ascending aorta was severely atherosclerotic with calcification, whose respiratory function was compromised, or whose renal function was compromised. A patient with a concomitant malignant neoplastic disorder was also a candidate for OPCAB because of the possible deleterious effect of CPB on the immune system. More recently, when the coronary anatomy was suitable for OPCAB, even in younger or less risky patients, OPCAB was indicated. The OPCAB procedure was performed through a median sternotomy in 146 patients (80.6%), a left thoracotomy in 27 (14.9%), a subxiphoid approach in 6 and a combined one in 2. One hundred and eleven patients (61.3%) received 1 or 2 grafts (Group I) and 70 (38.7%) received 3 or more grafts (Group II). The number of grafted vessels in Group II patients was 3 to 5 with a mean of 3.44. The mean operative time was 163 minutes in Group I and 209.5 minutes in Group II. The frequency of the use of arterial grafts such as LITA, RITA and RA was significantly higher in Group II than in Group I. Death occurred in 3 patients with acute coronary syndrome who had to undergo urgent surgery. Angiographic examination was performed within 3 months, postoperatively, in 98 patients (54.1%) revealing the overall patency rate of each graft: LITA82/83 (98.8%), RITA 33/33 (100%), GEA 15/16 (93.8%), RA 20/20 (100%), and SVG 15/16 (93.8%). We conclude that, in light of our 5-year experience, off-pump CABG on a beating heart can be safely and effectively performed, with acceptable angiographic results even in patients with multi-vessel coronary disease requiring multiple revascularization. This procedure enables us to perform successful coronary bypass surgery for those who otherwise would not have been candidates for conventional CABG.

Dobutamine echocardiography in predicting improvement in global left ventricular systolic function after coronary bypass or angioplasty in patients with healed myocardial infarcts

The aim of this study was to determine whether low-dose dobutamine ecnocardiography (DE) could predict quantitative improvement in global left ventricular (LV) systolic function after coronary revascularization. Low-dose DE was performed in 71 consecutive patients with coronary artery disease and LV dysfunction. Successful coronary bypass surgery or angioplasty was performed in 44 patients, 37 of whom had a resting echocardiogram 1 to 3 months afterward. Group A consisted of 20 patients with contractile reserve during DE, and group B consisted of 17 patients without contractile reserve. As expected, regional wall motion score index (mean ± SD) improved in group A (1.62 ± 0.39 to 1.38 ± 0.31, p < 0.01) but not group B (1.56 ± 0.42 to 1.57 ± 0.41, p = NS). In addition, LV ejection fraction (LVEF) improved after bypass surgery or angio plasty in group A (38 ± 5% to 42 ± 5%, p < 0.01), but not in group B (38 ± 7% to 39 ± 8%, p = NS). In group A, a significant linear correlation was observed between the number of segments with contractile reserve and the improvement in LVEF (r = 0.91, p < 0.0001). A good correlation also existed between the improvement in regional wall motion score index during dobutamine infusion and the improvement in LVEF after bypass surgery or angioplasty (r = 0.90, p < 0.0001). In conclusion, low-dose DE can be used to predict quantitative improvement in global LV systolic function after coronary bypass or angioplasty.

Effects of coronary angioplasty on left ventricular function

It is well known that myocardial revascularization after successful coronary bypass surgery results in improved left ventricular function. Coronary angloplasty also results in successful revascularization, favorably affecting both stunned and hibernating myocardium. We studied 22 patients with chronic stable angina who underwent suc cessful angloplasty for an isolated narrowing of the proximal or midportion of the left anterior descending artery. These patients also performed isometric exercises before and after angloplasty, which can be used to characterize left ventricular function. Revasculartzation after angloplasty induced an immediate improvement in left ventricular function in those patients with dysfunction secondary to hibernating myocardium. Further studies are needed to assess the possibility of the myocardial stunning phenomenon occurring after angloplasty in those patients without left ventricular improvement.

Kawasaki Syndrome in 18 Children in the West of Scotland

Analysis of the case records of 18 children admitted to the Royal Hospital for Sick Children, Glasgow between June 1981 and May 1990 satisfied the diagnostic criteria of Kawasaki syndrome as published by Japan's Kawasaki disease research committee in September 1984. No aetiological agents were implicated. All children had cardiological work-ups including chest x-ray, ECG, 2-D echocardiography. Two children had gammaglobulin therapy and 16 had treatment with aspirin. All children except one recovered without sequelae. The child with right coronary artery aneurysm has since had successful coronary bypass surgery.

Transesophageal Doppler assessment of reversible myocardial diastolic dysfunction after successful coronary bypass surgery

Transesophageal Doppler assessment of reversible myocardial diastolic dysfunction after successful coronary bypass surgery

Life-Threatening Ventricular Tachycardia and Fibrillation Induced by Painless Myocardial Ischemia During Exercise Testing

The clinical importance of myocardial ischemia without associated symptoms in patients with atherosclerotic coronary disease has not been clarified. We present three patients in whom painless cardiac ischemia was associated with the induction of cardiac arrest and/or ventricular tachycardia/fibrillation. In the two surviving patients, programmed ventricular stimulation did not induce ventricular arrhythmias. In one patient, successful coronary bypass surgery resulted in the elimination of exercise-induced painless myocardial ischemia and associated ventricular fibrillation; the other patient suffered a myocardial infarction after which ischemia and ventricular tachyarrhythmias could not be reproduced with exercise testing. We conclude that painless myocardial ischemia can cause life-threatening arrhythmias and is, therefore, a potentially lethal phenomenon.

Aortic Pseudo-Aneurysm with Aspergillus Aortitis: An Unusual Complication of Coronary Bypass Surgery

This is the first report of fatal postoperative Aspergillus infection in an aortic pseudoaneurysm associated with a jet lesion produced by a deformed, but hemodynamically normal aortic valve. Widespread arterial embolization was the principal feature and resulted in death on the 12th hospital day due to massive thromboembolism to the brain three months after successful coronary bypass surgery. Possible sources of such infections and the potential effect of the jet lesion are discussed.

Thrombolytic therapy during acute myocardial infarction due to sudden occlusion of the left main coronary artery

Two patients who suffered from sudden occlusion of the left main coronary artery were successfully treated with intracoronary infusion of streptokinase. One of them underwent successful coronary bypass surgery and the other was treated with medical therapy only. The outcome of this highly lethal condition is discussed.

FATAL ATHEROSCLEROSIS DEVELOPED IN LESS THAN 4 YEARS IN AORTOCORONAR VEIN GRAFT IN A HYPERLIPIDEMIC PATIENT

It is generally believed that it takes decades to develop a complicated atherosclerotic plaque. This view is challenged by the present case describing a hyperlipidemic patient who died of vein graft atherosclerosis less than 4 years after otherwise successful coronary bypass surgery. Although the atherogenesis may be accelerated in autogenous coronary vein grafts compared with native coronary arteries, the present case illustrates that complicated atherosclerosis may develop in the course of only a few years if appropriate conditions prevail.

A survey of uncommon forms of coronary arteries.

Among 854 coronary angiograms, we found the following abnormalities of the coronary arteries. Three cases had nonatherosclerotic coronary artery aneurysms. One case, a 27-year-old man with a diffuse lesion, expired after two episodes of myocardial infarction. In 2 other cases the lesions were localized and the patients underwent successful coronary bypass surgery. In 2 cases, a small vascular network was found: a 23-year-old man with pheochromocytoma who also had myocardial injury and pulmonary edema, and a case with contusio cordis who had angina pectoris but had normal coronary arteries. In 3 cases the coronary arteries originated abnormally from the aorta. A congenital right coronary artery-right ventricular fistula was detected in a 17-year-old female with multiple cardiac abnormalities. Abnormally wide coronary arteries were also found in 17 cases with apical hypertrophy, a form of hypertrophic nonobstructive cardiomyopathy.