1/53. Spontaneous recanalization of postoperative severe graft stenosis. What is the cause and prognosis of the "string sign" in the internal thoracic artery?A 68-year-old female with unstable angina was treated surgically. She was referred to the surgical ward by cardiologists because of a diagnosis of unstable angina with three vessel disease. On a coronary angiogram (CAG), 90% stenoses were found in the left anterior descending coronary artery (LAD), circumflex (CX), and right coronary artery (RCA). She received elective coronary artery bypass grafting (CABG), in which the left internal thoracic artery (LITA) was anastomosed to the LAD and reversed saphenous vein grafts (SVG) were made to segment 12 of the CX, and segment 4PD of the RCA, respectively. The postoperative course was uneventful, but postoperative early graftgraphy revealed distal narrowing of the LITA graft as the so-called "string sign". However, one year post surgery, the LITA string sign was not found and its patency had markedly improved on the second graftgram. It is reported that the LITA "string sign" might cause late graft occlusion. However, this LITA graft evidently enlarged the size and increased the flow of the artery in proportion to myocardial blood demand. To our knowledge, it has not been reported that an in situ LITA string sign on postoperative early graftgram has disappeared in the late phase. We hypothesize that the LITA string sign might be caused by several different factors such as flow competition, spasm, and/or technical problems. In any event, the LITA string sign does not cause graft occlusion in the late postoperative period in every case.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/53. thyrotoxicosis, unstable angina and normal coronary angiogram.It is well known that thyrotoxicosis may elicit acute myocardial ischemia even in patients with angiographically normal coronary vessels. The involved mechanisms are not clearly defined although some hypothesis have been suggested. We report a case of a 54-year-old woman affected by Graves' disease with thyrotoxicosis which was referred to our Institute because of unstable angina. During hospitalization a two dimensional echocardiogram, performed during chest discomfort, showed left ventricular apical akinesis and impaired global systolic function. A subsequent coronary angiography revealed normal epicardial vessels. She was successfully treated with high-dose methimazole and propranolol and a repeat echocardiogram evaluation showed normalization of left ventricular systolic function. Six months later, because of the appearance of paroxysmal atrial fibrillation, the patient underwent total thyroidectomy and a substitutive therapy with L-T4 (100 micrograms/die) was started. The authors review the possible mechanisms involved in the pathogenesis of myocardial ischemia during thyrotoxicosis.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/53. coronary artery bypass and superior vena cava syndrome.superior vena cava syndrome is the obstruction of the superior vena cava or its main tributaries by benign or malignant lesions. The syndrome causes edema and engorgement of the vessels on the face, neck, and arms, nonproductive cough, and dyspnea. We discuss the case of a 48-year-old obese diabetic woman who was admitted with unstable angina. She had previously been diagnosed with superior vena cava syndrome. Urgent coronary artery bypass grafting was necessary Although thousands of coronary artery bypasses are performed every year, there are not many reports on patients with superior vena cava syndrome who successfully undergo cardiopulmonary bypass and coronary artery grafting with an internal mammary artery as the conduit. The results of the case and alternative recommended methods are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/53. Usefulness of coronary MR angiography prior to angioplasty.The range of indications for percutaneous transluminal coronary angioplasty (PTCA) has increased greatly since the procedure was initially introduced. The success rate depends on the anatomy and length of the occlusion and on the state of the distal vessel. We present a case where the use of magnetic resonance angiography (MRA) allowed to evaluate the length of a subtotal occlusion prior to PTCA, and thus could have had an impact on therapeutic decisions. Coronary MR angiography is one of the many applications of breathhold MRI, where breathholding and segmented k-space acquisition are combined to provide anatomical images of coronary vessels. Coronary MR angiography allows reproducible visualization of coronary vessels. Even under adverse circumstances (poor cardiac triggering) the images are sometimes of sufficient quality to help make a diagnosis. This capability may increase the as yet limited clinical use of MR technology in the practice of cardiology.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
5/53. Transient microvascular vasoconstriction: a possible cause of unstable angina.We report the case of a 65-year-old woman who developed unstable angina 2 months after successful coronary angioplasty of the left anterior descending coronary artery. coronary angiography failed to show angiographic restenosis, but intracoronary ergonovine caused ST segment elevation and her habitual chest pain in the absence of epicardial coronary spasm and important pressure changes in the distal left anterior descending coronary artery assessed by a pressure wire, thus suggesting that distal vessel constriction was responsible for unstable angina.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/53. coronary artery bypass grafting following substernal gastric interposition.A 61-year-old man who had undergone substernal esophagogastric anastomosis for reconstruction after esophageal cancer, developed unstable angina 9 years later. Complete revascularization for triple-vessel disease was performed via a left thoracotomy approach under cardiopulmonary bypass. The successful results show that complete revascularization can be performed via this approach.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/53. Dystrophic calcification of the radial artery.The radial artery continues to enjoy resurgence in popularity as a conduit for coronary artery bypass grafting but few studies have examined the prevalence of preexisting disease in this vessel. We highlight a potential, avoidable pitfall when use of the radial artery for coronary artery bypass grafting is proposed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/53. Combined surgery for coronary artery disease and pheochromocytoma.PURPOSE: To report a case of severe coronary artery disease complicating pheochromocytoma, managed with combined coronary artery bypass grafting (CABG) and adrenalectomy. CLINICAL FEATURES: A 55-yr-old woman presented with poorly controlled hypertension and investigation revealed an active pheochromocytoma of her left adrenal gland. During medical preparation for adrenalectomy, she developed an acute myocardial infarct complicated with unstable angina. This required urgent CABG, and combined surgery for the triple vessels coronary artery disease and the pheochromocytoma was planned. We explain the details of medical preparation before surgery and the anesthetic considerations during the surgical procedure. Postoperative recovery was normal and no complication occurred. Even if the pheochromocytoma was malignant, her urinary catecholamines two months after the surgery were normal and remain normal after more than two years of follow-up. CONCLUSION: We report a patient who underwent combined CABG and adrenalectomy for pheochromocytoma. The CABG was done first, followed by the adrenalectomy with invasive monitoring. The procedure was well tolerated with cure of the two underlying conditions. So we propose that combined procedure should be considered in this clinical setting.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/53. Multiple coronary artery bypass grafting in dextrocardia: case report.This is a case report of an unusual case of a patient with dextrocardia and "situs inversus totalis" who presented with unstable angina. coronary angiography revealed severe main stem and severe triple vessel coronary artery disease. The patient later underwent successful emergency coronary artery bypass graft surgery. To the authors' knowledge this is the first reported case in malaysia and also, the first ever report in the literature of multiple vessel coronary artery grafting, including the use of the right internal mammary artery.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/53. Oblique aortic valve replacement and coronary artery bypass grafting for severely calcified narrow aortic root with unstable angina.We report an 84-year-old woman diagnosed with aortic stenosis and regurgitation with a severely calcified narrow aortic root and left main coronary artery trunk stenosis with triple-vessel coronary artery disease. Emergency aortic valve replacement and triple coronary artery bypass grafting were successful. The aortic annulus was small and heavily calcified, and the ascending aorta, the sinus of valsalva and the anterior leaflet of the mitral valve were severely calcified. A St. Jude Medical valve 19A (St. Jude Medical Inc., St. Paul, MN) was inserted obliquely along the noncoronary sinus. This technique is a useful alternative in cases where the patient's life is at risk in situations involving severe extensive calcification of a narrow aortic root.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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