Cases reported "Coronary Disease"

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1/331. Simultaneous operation for minimally invasive direct coronary artery bypass and abdominal aortic aneurysm repair.

    Simultaneous minimally invasive direct coronary artery bypass and abdominal aortic aneurysm repair were conducted in a 66-year-old man uneventful, requiring no transfusion. Surgery required 9 hours and 2 minutes. The tracheal tube was extubated in the operating room. Postoperative bleeding was 215 ml. The postoperative course was very smooth, with the patient able to walk on postoperative day 1. Postoperative coronary arteriogram and aortogram showed favorable results and the patient was discharged on day 23 after surgery.
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ranking = 1
keywords = operative
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2/331. Fatal cardiac ischaemia associated with prolonged desflurane anaesthesia and administration of exogenous catecholamines.

    PURPOSE: Four cardiac ischaemic events are reported during and after prolonged anaesthesia with desflurane. CLINICAL FEATURES: We have evaluated desflurane in 21 consecutive patients undergoing advanced head and neck reconstructive surgery. Four deaths occurred which were associated with cardiac ischaemic syndromes either during or immediately after operation. All patients in the study received a similar anaesthetic. This comprised induction with propofol and maintenance with alfentanil and desflurane in oxygen-enriched air. Inotropic support (either dopamine or dobutamine in low dose, 5 micrograms.kg.min-1) was provided as part of the anaesthetic technique in all patients. Critical cardiovascular incidents were observed in each of the four patients during surgery. These were either sudden bradycardia or tachycardia associated with ST-segment electrocardiographic changes. The four patients who died had a documented past history of coronary heart disease and were classified American Society of Anesthesiologists (ASA) II or III. One patient (#2) did not survive anaesthesia and surgery and the three others died on the first, second and twelfth postoperative days. Enzyme increases (CK/CK-MB) were available in three patients and confirmed myocardial ischaemia. CONCLUSION: These cases represent an unexpected increase in the immediate postoperative mortality for these types of patients and this anaesthetic sequence.
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ranking = 0.5
keywords = operative
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3/331. Secondary transmyocardial laser revascularization in the treatment of end-stage coronary artery disease.

    transmyocardial laser revascularization (TMR) has received more acceptance within the last few years. The vast majority of TMR users report impressive clinical benefits. The underlying mechanism for benefit by TMR, however, remains somewhat unclear. Between July 1994 and September 1997, 165 patients underwent TMR at our institution. In three of our TMR patients after an initial angina-free interval of 1 to 2 years we decided to repeat the laser operation. This article focuses on the three re-TMR patients who underwent a second TMR operation 12 to 14 months after the first one. Two of the three patients are well and experience significantly less angina than preoperatively.
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ranking = 0.25
keywords = operative
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4/331. Integrated approach for revascularization in multivessel coronary artery disease and porcelain aorta.

    We report two cases in which combined beating heart revascularization of the left anterior descending artery (LAD) and percutaneous angioplasty of the non-LAD target arteries were adopted after the intraoperative detection of porcelain aorta and impossibility to complete surgical revascularization. This type of strategy preserves the benefits of surgical LAD grafting and complete revascularization and results in a simple and low-risk technical procedure in an otherwise challenging setting.
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ranking = 0.25
keywords = operative
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5/331. 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.
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ranking = 2
keywords = operative
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6/331. Is the presence of surgically treatable coronary artery disease a contraindication to liver transplantation?

    Advanced coronary artery disease has been traditionally considered an absolute contraindication to orthotopic liver transplantation where chronic liver failure significantly increases the surgical risk for coronary artery bypass grafting. Performing a simultaneous coronary artery bypass grafting and liver transplant is a theoretically attractive strategy in liver transplant candidates with coronary artery disease in need of revascularization. In the present article, we report a successful simultaneous coronary artery bypass grafting and orthotopic liver transplant with 1-yr post-operative follow-up and we discuss the rationale for this approach. In selected cases, the presence of advanced coronary artery disease should not be considered an absolute contraindication to liver transplantation.
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ranking = 0.25
keywords = operative
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7/331. Left ventricular ischemia due to coronary stenosis as an unexpected treatable cause of paroxysmal atrial fibrillation.

    We present a patient with exercise-induced paroxysmal atrial fibrillation who was eventually scheduled for a Cox-maze operation due to persistence of his complaints of fatigue, impaired exercise tolerance, and predominantly exercise-related irregular palpitations despite treatment with several antiarrhythmic drugs. A preoperative exercise stress test without antiarrhythmic or negative chronotropic drugs, however, showed clear evidence of myocardial ischemia. After coronary angioplasty of a significant stenosis in the left anterior descending artery, there was no recurrence of atrial fibrillation during a follow-up of 7 months.
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ranking = 0.25
keywords = operative
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8/331. Intraoperative monitoring of regional wall motion abnormalities for detecting myocardial ischemia by transesophageal echocardiography.

    Transesophageal two-dimensional echocardiography has been used for intraoperative monitoring of regional wall motion of the left ventricle. Regional wall motion abnormality is a sensitive indicator of myocardial ischemia and the use of two-dimensional transesophageal echocardiography may have a substantial advantage for early detection of myocardial infarction and thus for initiating timely and appropriate therapy in preventing postoperative myocardial ischemia. With an expected increase in the use of intraoperative transesophageal echocardiography for monitoring regional wall motion, we described the practical aspects of transesophageal echocardiography: (1) insertion technique of transesophageal echocardiographic probe; (2) the technique for obtaining an optimal short-axis view of the left ventricle; and (3) the method for evaluating regional wall-motion abnormality and myocardial ischemia. Regional wall motion abnormality is best monitored at the mid-papillary muscle level where all three coronary arteries meet. In obtaining this view, the transesophageal echocardiographic probe was found to be predominantly located in the stomach. Failure in obtaining short-axis view of the left ventricle at this level occurred in patients with left ventricular dilatation or obesity. Because of the anatomical reason, the echocardiographic transducer cannot reach a proper plane. In anesthetized patients, air can be pushed into the stomach during induction and may disturb the visualization. The pitfalls in examining regional wall motion abnormalities include: (1) shifting of the center of left ventricular contraction; (2) inadequate direction of the scanning plane; and (3) paradoxical septal movement. Three cases are presented to demonstrate the usefulness of transesophageal echocardiography in managing coronary artery surgical patients.
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ranking = 1.75
keywords = operative
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9/331. myocardial infarction caused by compression of anomalous circumflex coronary artery after mitral valve replacement.

    We report a case of myocardial infarction after mitral valve replacement occurring in a patient with the left cyrcumflex coronary artery arising from the right one. The patient underwent mitral valve replacement with a size 27 Carbomedics prosthesis and a tricuspidal annuloplasty was performed according to the De Vega technique. Patient died on the 20th postoperative day.
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ranking = 0.25
keywords = operative
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10/331. Concomitant coronary artery revascularization and right pneumonectomy without cardiopulmonary bypass.

    Combined coronary artery bypass grafting (CABG) and pneumonectomy has a high morbidity and mortality rate, especially when the right lung has to be removed. A patient is described who underwent a CABG operation through a midline sternotomy without the use of cardiopulmonary bypass (CPB), and a right pneumonectomy through a right lateral thoracotomy in one operative session. To our knowledge, this is the first case in which this operative strategy was employed. CABG operations without the use of CPB might put concomitant lung surgery in a new perspective.
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ranking = 0.5
keywords = operative
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