1/239. 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 = artery (Clic here for more details about this article) |
2/239. Late development of an aneurysm of a saphenous vein used as an aortocoronary conduit.A case of a large saphenous vein aortocoronary aneurysm that developed late after coronary artery bypass grafting is presented. This is the first case of a large saphenous vein aortocoronary aneurysm identified by serial angiography and 3-dimensional computed tomographic scanning.- - - - - - - - - - ranking = 0.11111111111111keywords = artery (Clic here for more details about this article) |
3/239. Mesenteric ischemia after coronary artery bypass grafting: should local continuous intra-arterial perfusion with papaverine be regarded as a treatment?Mesenteric ischemia after cardiac surgery is rare but dramatic. We present a patient who had acute mesenteric ischemia following low cardiac output after coronary artery bypass grafting. Our patient was successfully treated with continuous intra-arterial perfusion with papaverine. We think that selective angiography must be performed as early as mesenteric ischemia is suspected, to get earlier diagnosis and treatment of an ischemic patient.- - - - - - - - - - ranking = 0.55555555555556keywords = artery (Clic here for more details about this article) |
4/239. Interesting cases from the University of texas Medical Branch.This article discusses the cases for four patients with unstable angina. The first case is an example of the "high-risk" patient with widespread ECG changes, heart failure, and enzymatic elevations during an episode of chest pain. The second patient illustrates an unusual cause of unstable angina in a young women. The third patient had a large thrombus visible on angiography and management strategies for dealing with intracoronary thrombus are discussed. The final patient had an extensive past cardiac history with two prior coronary artery bypass operations and we discuss the recent advances made in the treatment of degenerative vein graft disease.- - - - - - - - - - ranking = 0.11111111111111keywords = artery (Clic here for more details about this article) |
5/239. coronary artery bypass graft after esophagogastrectomy.A 71-year-old male with a history of retrosternal gastric bypass, after a resected esophageal carcinoma, developed angina pectoris due to stenosis of the left main trunk and the left anterior descending artery. The patient was treated with off-pump beating-heart coronary artery bypass approached via left thoracotomy. Two free conduits arising from the left internal mammary artery were utilized for this particular case, since the aortocoronary bypass was impossible due to the severely calcified aorta. Postoperative angiography confirmed good coronary flow and the patient has been symptom free for 6 months.- - - - - - - - - - ranking = 0.77777777777778keywords = artery (Clic here for more details about this article) |
6/239. Angina and coronary ostial lesions in a young woman as a presentation of Takayasu's arteritis.Diagnostic considerations in young patients presenting with coronary artery disease have conventionally included familial dyslipidemias, lipoprotein(a) elevation, hyperhomocysteinemia, cocaine toxicity, hypercoagulable states, connective tissue disorders, vasculitis and the presence of other established risk factors for coronary artery disease. The case of a young woman with unstable angina and a left main coronary artery ostial lesion on cardiac catheterization is discussed. She was subsequently diagnosed with Takayasu's arteritis 4 years later.- - - - - - - - - - ranking = 1.4089019748197keywords = artery disease, artery (Clic here for more details about this article) |
7/239. Possible anaphylactic reaction to abciximab.We report a patient who experienced a severe anaphylactic reaction during coronary artery stenting. Subsequent to administration of a weight-adjusted dose of abciximab, the patient developed profound hypotension and severe, acute airway obstruction. The reaction was successfully reversed with a 16-hr infusion of epinephrine, steroids, and an H1 blocker. Cathet. Cardiovasc. Intervent. 48:71-73, 1999.- - - - - - - - - - ranking = 0.11111111111111keywords = artery (Clic here for more details about this article) |
8/239. Improved cerebral perfusion after stenting of a petrous carotid stenosis: technical case report.OBJECTIVE AND IMPORTANCE: Atherosclerotic occlusive disease of the intracranial vasculature is associated with increased risk of systemic vascular occlusive disease and stroke. Therapeutic options have included anticoagulation therapy, antiplatelet therapy, or, in a limited number of patients, extracranial-intracranial vascular bypass procedures. We report a patient who had improved cerebral perfusion with silent watershed zone infarctions after endovascular stenting of a severe petrous segment carotid stenosis. CLINICAL PRESENTATION: A 73-year-old man with severe coronary artery disease and unstable angina was referred for treatment of a 90% right petrous carotid artery stenosis before coronary artery bypass grafting. A brain single-photon emission computed tomographic scan using 99mTc-bicisate revealed diminished perfusion throughout the right internal carotid artery territory, particularly in posterior watershed zones. TECHNIQUE: The patient underwent transfemoral placement of a 7-French introducer sheath, followed by a 7-French guide catheter. Urokinase (225,000 U) was infused through a microcatheter placed proximal to the lesion. No changes were noted in lesion morphology after this infusion. A microguidewire was navigated across the lesion. Subsequent balloon angioplasty with a coronary artery balloon was performed twice, followed by placement of a 4- x 12-mm coronary stent. CONCLUSION: Selective internal carotid artery angiography after stenting revealed markedly improved flow. A brain 99mTc-bicisate single-photon emission computed tomographic scan performed within 24 hours of stent placement, revealed significantly improved perfusion within the right internal carotid artery territory. Two perfusion voids suggestive of embolic stroke were noted; both were clinically silent. The patient had uncomplicated coronary artery bypass grafting 72 hours later. Five months postoperatively, he remains at home, living independently and with intact neurological function. Intracranial stenting for severe atherosclerotic stenosis is technically possible. However, its ultimate clinical role remains to be determined.- - - - - - - - - - ranking = 1.5195273016854keywords = artery disease, artery, carotid, carotid artery (Clic here for more details about this article) |
9/239. Minimally invasive axillary-coronary artery bypass for acute occlusion of the coronary artery.We performed minimally invasive axillary-coronary bypass using a reversed saphenous vein graft to treat a patient with acute occlusion of the left anterior descending artery after failed percutaneous transluminal coronary angioplasty (PTCA). For patients with acute myocardial ischemia, this procedure is useful to reduce the ischemic time and is less invasive. We believe this procedure may be an alternative intervention for selected patients with acute myocardial infarction or unstable angina after PTCA. However, a large series with sufficient follow-up and late angiography is required to evaluate the long-term patency and effectiveness of this approach.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
10/239. 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 = 0.88888888888889keywords = artery (Clic here for more details about this article) |
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