We report two patients with acquired fistulas between the internal mammary and pulmonary arteries after coronary bypass surgery. This is a rare complication of bypass surgery and may be a cause of recurrent angina postoperatively due to coronary artery steal. A table of all the cases reported in the literature ...

BACKGROUND: The prevalence of intercostal nerve damage associated with coronary artery bypass graft-internal thoracic (mammary) artery surgery is unknown. METHODS: A total of 37 consecutive patients with coronary artery bypass graft surgery (all with left internal thoracic artery graft) who were attending a cardiac-related exercise program underwent a thorough examination. ...

Coronary artery bypass grafting (CABG) in patients with severe pectus excavatum is a surgical challenge. A two-stage correction of sternal deformities and cardiac lesions has been described and myocardial revascularization through a left lateral thoracotomy is a valid alternative in urgent situations. We report a one-stage repair of severe pectus ...

We describe a patient who underwent minimally invasive direct coronary artery bypass (MIDCAB), who had previously undergone coronary artery bypass grafting (CABG) through a median sternotomy with a left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD) and a right gastroepiploic artery (GEA) graft to the ...

The major limitations of current minimally invasive direct coronary artery bypass (MIDCAB) techniques are multivessel and distal vessel disease frequently seen in patients with extensive stent restenosis ('full metal jacket syndrome') and reoperative surgery. Two separate minimal access incisions (minithoracotomy, lower partial sternotomy) have been used to bypass two separate ...

The aim of this study was to determine the ability of human mammary artery cells to maintain a metabolic activity by measuring the artery concentration of two vasoactive substances, endothelin-1 (ET-1) and cyclic guanosyl monophosphate (cGMP), and a neurohumoral substance-neuropeptide Y (NPY)-prior to and following cryostorage. Ten distal segments of ...

The concentrations of two antibiotics (vancomycin and cefuroxime) in sternal bone during coronary artery bypass surgery were analyzed to examine whether antibiotic penetration is impaired after dissection and harvesting of the left internal mammary artery for grafting. Bone samples (250 mg of cancellous sternal bone from both halves of the ...

OBJECTIVE: To compare radial artery (RA) patency with internal mammary artery (IMA) patency for coronary artery bypass surgery in our early experience. METHODS: Symptomatic as well as asymptomatic patients with > or =1 RA coronary graft underwent postoperative angiography. Each anastomosis was considered separately. A string sign referred to a ...

A case of heart transplantation with concomitant coronary artery bypass graft is reported. The patient was an alternate transplant list candidate with a history of bilateral below-knee amputation and 2 previous myocardial revascularization procedures. The previously used and patent left internal mammary artery graft was successfully removed and retransplanted from ...

BACKGROUND: Bilateral internal mammary artery (IMA) grafting is performed to provide complete arterial myocardial revascularization with the intention of decreasing postoperative return of angina and the need for reoperation. We present here technical views of double-skeletonized IMA grafting, and evaluate its clinical outcome. METHODS: Skeletonized IMA is harvested gently with ...

Reverse flow in the internal mammary artery coronary graft in the presence of subclavian stenosis is rare. We describe a 67-year-old man who 7 years after coronary artery surgery was admitted with left subclavian artery stenosis and retrograde flow in the pedicled left internal mammary artery graft. Subsequent redo triple ...

It has been shown previously that the internal mammary artery releases more cyclic guanosine monophosphate after stimulation with atrial natriuretic peptide than the saphenous vein, and that C-type natriuretic peptide possesses a cyclic guanosine monophosphate stimulating potential on saphenous vein bypass grafts. The present study was undertaken to investigate intracellular ...

Minimally invasive direct coronary artery bypass has the potential to cause an anastomotic failure because of a limited exposure of the operative field and the difficulty of internal thoracic artery harvesting. In the present study, the importance of preoperative marking for an accurate minithoracotomy location and a successful internal thoracic ...

BACKGROUND: Successful endoscopic harvesting of arterial conduits is critical to the performance of totally endoscopic bypass grafting. Recent success with computer-enhanced robotic systems in the performance of endoscopic single vessel coronary artery bypass (ENDOCAB) has paved the way for developing techniques for multivessel ENDOCAB. The Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, ...

BACKGROUND: The introduction of robotic-enhanced endoscopic instrumentation systems allows the surgeon to perform arterial revascularization for multivessel coronary artery disease without sternotomy. METHODS: From April 1999, 27 patients (6 female, 21 male, median age 63 +/- 8.2 years) suffering from multivessel coronary artery disease were treated surgically using arterial revascularization ...

BACKGROUND AND AIMS: The increasing incidence of reoperations in coronary surgery associated with higher perioperative risks is a challenge for refinement of the surgical methods. The aim of the work is to prove the feasibility and satisfactory intermediate results of minimally invasive axillary-coronary artery bypass reconstruction in redo coronary surgery ...

A new method of endoscopic ultrasonography during endoscopic bypass grafting is described. Using a 7.5 MHz ultrasonic catheter (AcuNav, Acuson, Mountain View, CA) that was introduced through a 5mm port and manipulated by robotically enhanced endoscopic instruments, detection of the internal thoracic artery (ITA) and the left anterior descending (LAD) ...

The internal (thoracic) mammary artery (IMA) is currently the vessel of choice for coronary artery bypass grafting (CABG), due to its long term patency. The purpose of this study was to compare the incidence and nature of musculoskeletal and neurological complications following saphenous vein grafting (SVG) and internal mammary artery ...

BACKGROUND: In spite of advances in the management of bleeding associated with cardiac surgery, hemorrhage remains a troublesome problem, particularly in complex cases and high risk patients. In minimally invasive cardiac surgery, limited exposure and tight quarters may make accurate suturing difficult, and increase the risk of surgical bleeding. A ...

When a left anterior descending coronary artery passes over the cardiac apex and presents with 2 stenoses, 1 proximal and 1 distal, the available bypass conduit often is too short to enable both the anastomosis below the distal stenosis and the sequential anastomosis on the arterial segment between the 2 ...

Internal mammary arteries are the grafts of choice for coronary artery bypass because they are generally free of atherosclerosis and they have high patency rates as grafts. There are, however, increasing reports of graft failure due to diffuse or distal narrowing, known as the string phenomenon. From June 1999 to ...

BACKGROUND: The recent development of off-pump and minimally invasive techniques in coronary artery bypass grafting (CABG) has provided the surgeon with multiple options in performing redo revascularization procedures. METHODS: We retrospectively analyzed our early results in off-pump redo CABG procedures. Between January 1998 and January 2000, we performed 55 off-pump ...

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' ...

BACKGROUND: The increasing number of patients of more advanced age undergoing cardiac surgery means the number of those with previous curative (relapse free) mastectomy and irradiation of the chest is also increasing. A higher incidence of postoperative complications such as sternal infection in these patients is considered possible. Furthermore the ...

BACKGROUND: The skeletonization of internal thoracic artery is postulated to improve graft length, early blood flow, sternal blood supply, and postoperative respiratory function. Concern exists that skeletonization may injure internal thoracic artery, precluding good results of surgery. Reports on endothelial function of skeletonized internal thoracic artery are lacking. METHODS: A ...

The internal mammary artery is the preferred conduit for coronary bypass grafting; however, suboptimal flow through the internal mammary artery is sometimes found during the operation, and the conduit is abandoned. Subclavian artery stenosis, a well-recognized cause of reduced internal mammary artery flow, is easily and effectively treated with endovascular ...

The aim of this study was to assess the need for preconditioning and/or exclusion of competitive flow in minimally invasive coronary bypass grafting procedures (MICAB), to prevent early graft occlusion. Eight mongrel dogs (+/- 25 kg) were operated on under intravenous anaesthesia (sodium thiopenthal 15 mg/kg) and maintained with Halothan ...

We report a patient in whom coronary artery bypass grafting with the left internal mammary artery to the left anterior descending coronary artery and laser transmyocardial revascularization were simultaneously performed through a left small thoracotomy. The patient recovered uneventfully and 9 months following surgery he is free of angina and ...

BACKGROUND: The superior long-term patency of internal mammary artery coronary bypass grafts compared with venous grafts has been attributed in part to increased endothelium-derived nitric oxide (. NO) production. Interest in the radial artery as an alternative bypass conduit has recently been revived; however, its biological characteristics remain incompletely defined. ...

The internal mammary artery (IMA) and the gastroepiploic artery (GEA) are frequently used to construct coronary artery bypass grafts. In order to determine and to compare their contractile properties, we studied the effects of constricting agents which are liberated or infused during coronary bypass surgery. IMA and GEA were arranged ...

BACKGROUND: Total arterial myocardial revascularization (TAMR) is feasible because of the excellent long-term patency of the arterial conduits. We present five new surgical configurations for TAMR. METHODS: Between December 1998 and July 1999, 34 patients with triple vessel disease underwent TAMR. All patients were in CCS III or IV. Sketelonized ...

We present a new technique for avoiding possible kinking or angulation of the sequential left internal mammary artery to left anterior descending artery (LIMA-LAD) anastomoses when the LAD follows an intramuscular course. A 3- to 5-mm cusp of saphenous vein segment is interposed between the intramuscular LAD segment and internal ...

BACKGROUND: The hypothesis that persistence of undivided branches is a common finding after myocardial revascularization using the left internal mammary artery was explored. METHODS: Three hundred seven consecutive postoperative angiographies of the left internal mammary artery were considered. Seven were excluded because of occlusion or malfunction of the conduit or ...

BACKGROUND: The pedicled (in-situ) left internal mammary artery grafted to the left anterior descending artery has a very high late patency and reduces late mortality following coronary artery bypass surgery. A technique is described which achieves total arterial revascularization in patients with multivessel coronary disease and which is also entirely ...

New surgical techniques for the treatment of the isolated lesion of the left anterior descending coronary artery (LAD) include off-pump surgery, minimal access to the heart, and endoscopic or computer enhanced coronary artery bypass surgery. The term minimally invasive direct coronary artery bypass surgery (MIDCAB) is related to a left-side ...

In this report, we describe an alternative method to the conventional arteriographic techniques of the left internal mammary artery (LIMA) graft using a balloon-tipped floatation catheter placed within the left subclavian artery. The floatation catheter will serve as both an occluder of the subclavian artery as well as a port ...

OBJECTIVE: The internal thoracic artery has become the conduit of choice for coronary artery bypass grafting. To avoid spasm of the artery, and increases in its diameter and flow, various vasodilators have been used either intraluminally or by topical application by different surgeons. In order to define the best vasodilating ...

OBJECTIVE: Complete arterial coronary artery bypass grafting with 2 grafts can be achieved even in triple vessel disease by use of a T configuration. There is still uncertainty whether the coronary flow reserve in the main stem of the left internal thoracic artery is sufficient to supply more than 1 ...

The aim of this interdisciplinary study was to evaluate power Doppler imaging as a method of collecting reliable preoperative data concerning the diameters and topography of exemplary internal mammary vessels as recipient vessels in reconstructive microsurgery. Thirteen female patients (range, 37 to 58 years; mean, 45.6 years) were examined preoperatively ...

BACKGROUND: It has been stated that thoracoscopic internal thoracic artery (ITA) mobilization is not recommended in the redo minimally invasive direct coronary artery bypass (MIDCAB) situation, presumably because adhesions from the previous coronary artery bypass grafting operation may preclude a thoracoscopic approach. However, there are advantages to thoracoscopic ITA mobilization ...

BACKGROUND: Internal mammary artery (IMA) as conduit for a coronary artery bypass graft (CABG) stays patent longer and more often than saphenous vein (SV). However, the precise differences in the biology of IMA and SV are unclear. METHODS AND RESULTS: To examine inherent difference in superoxide anion, superoxide dismutase (SOD) ...

BACKGROUND: Due to limited range of motion, endoscopic multivessel revascularization is difficult through a thoracic approach. METHODS: A computer-enhanced surgical telemanipulation system was used to perform transabdominal endoscopic grafting (TCAB) in an experimental cadaver model. After incising the membranous portion of the diaphragm, pericardium, and pleura, dissection of the left ...

A 61-year-old male was referred to the surgical ward by cardiologists because of a diagnosis of unstable angina with 3-vessel disease. On preoperative left internal thoracic arteriography, a large first intercostal branch was found at the proximal portion. Selective arterial embolization of the branch of the left internal thoracic artery ...

Despite its merits, minimally invasive direct coronary artery bypass surgery (MIDCAB) has been criticized for variable left internal mammary artery (LIMA) graft patency rates, prompting the frequent use of postoperative LIMA angiography. Noninvasive transthoracic Doppler interrogation of LIMA grafts has recently been shown to have utility for assessing patency and ...

BACKGROUND: The purpose of this study was to examine the feasibility of performing totally endoscopic myocardial revascularization through the abdominal cavity. METHODS AND RESULTS: The right gastroepiploic artery was harvested endoscopically through three troacars in 46 human cadavers. Then, a 5-cm hole was made in the diaphragm to expose the ...

BACKGROUND: To achieve an endoscopic coronary bypass anastomoses we performed a study with endoscopic robotic instrumentation and camera guidance using three-dimensional (3-D) visualization. METHODS: The surgical robotic system ZEUS (Computer Motion Inc, Goleta, CA) consists of three interactive robotic arms and a control unit allowing the surgeon to move the ...

Genus Gordona is included in mycolic acid containing bacteria. This genus infection is very rare and occurs classically in immuno-compromised patients. We report a patient who developed mediastinitis due to Gordona sputi after coronary artery bypass grafting (CABG) using left internal mammary artery. Immunocompromised factors were not noticed in this ...

The aims of this study were to assess the feasibility of routine transradial coronary angiography in a standard population of patients with presumed coronary artery disease over a period of time long enough to allow for technical evolution and evaluation of a single operator's learning curve, and to provide data ...

The purpose of the investigation was to examine the response of the milk vein and the mammary artery to potential vasoactive substances in lactating sows. The response on artery and vein segments from the same sow was measured for the following substances: noradrenaline (NA), serotonin (5-HT), prostaglandin F2alpha (PGF2alpha), prostacyclin ...

OBJECTIVE: This study prospectively evaluates the effect on sternal vascularity of harvesting the left internal thoracic artery. METHODS: Twenty-four consecutive patients undergoing primary coronary artery bypass grafting were studied. One patient's procedure was altered during the operation, and he was eliminated from the study. The patients were prospectively randomized to ...