We present two cases of an extrapleural hematoma, on a follow-up chest X-ray after coronary artery bypass surgery using an internal mammary artery (IMA). In both cases, the finding was disclosed on a routine chest film obtained 1 month post-operatively, in a patient who was either asymptomatic or had nonspecific ...

Thromboangiitis obliterans is an inflammatory peripheral vascular disease that is strongly associated with smoking. It predominantly affects distal small- and medium-sized blood vessels of both the upper and lower extremities. We present histological evidence of this disease process affecting the internal mammary arteries. This can be of paramount clinical significance ...

Anomalous origin of the main coronary arteries from the aorta is rare. We report a case with a single coronary artery from the right sinus of Valsalva associated with atherosclerosis. The patient was treated with a coronary artery bypass procedure: left internal mammary artery (LIMA) to the left anterior descending ...

In patients with end-stage renal disease undergoing hemodialysis, the upper extremity arteriovenous (AV) fistula is the dialysis access recommended by the DOQI guidelines for patients with appropriate vasculature. Upper extremity AV fistulae have long periods of usefulness, high flow rates, and low associated complication rates. Placement of AV access may ...

Aortic valve replacement in patients with a patent left internal mammary artery graft is often a challenge because of the difficulties with dissection of the left internal mammary artery and optimum myocardial protection. We describe a simple technique of aortic valve replacement with a beating heart and continuous coronary perfusion ...

Although spinal ischemia is a very well recognized complication after operation on the thoraco-abdominal and abdominal aorta, it is very rare following coronary artery bypass surgery. A case of a 56-year-old man, who had juxtarenal aortic occlusion and became paraplegic after internal mammary artery grafting for ischemic heart disease is ...

BACKGROUND: Complete surgical revascularization that includes left internal thoracic artery grafting to the left anterior descending coronary artery remains the gold standard of treatment for coronary artery disease. Not all patients are good candidates for sternotomy. Therefore, we sought to identify a strategy that would combine the long-term advantages of ...

BACKGROUND: Although techniques for off-pump coronary artery bypass grafting (CABG) are continually being refined, angiographic follow-up studies have indicated a higher rate of anastomoses-related stenoses than expected after traditional on-pump CABG. This study was performed to evaluate the use of intraoperative epicardial color Doppler ultrasound to quality-assess left internal mammary ...

The use of the internal mammary artery (IMA) in coronary artery bypass graft surgery is an independent predictor of late survival in all subsets of patients and should not be denied to any subgroup. Therefore damage to the IMA during harvesting is a catastrophic complication after which the graft is ...

A 50-year-old man developed recurrent angina 1 year after coronary artery bypass surgery. The patient was found to have a large fistula involving branches of the internal mammary artery graft and the left pulmonary artery. In the absence of another clear cause for the patient's symptoms, we speculated that our ...

We report the case of a 56-year-old symptomatic woman who underwent 2 coronary bypasses (left internal mammary artery on the left anterior artery and saphenous venous bypass on the circumflex) for a tight stenosis of the left main coronary. An inflammatory syndrome had been explored for 1 year without specific ...

In this study, we investigated the short-term effect of 17 beta-oestradiol on functional enzyme activity (FEA) of endothelin-converting enzymes in vitro using human internal mammary arteries (n=7-8) and human saphenous veins (n=16-17) obtained from patients undergoing coronary artery bypass graft surgery. Vascular rings were preincubated with either solvent control (0.2% ...

Increasing use of bilateral internal mammary arteries for coronary surgery will increase the number of interventions in these grafts. Such interventions may be technically challenging because of often tortuous and angulated vessels. We describe a technique to intubate an acutely angulated right internal mammary artery that was inaccessible with conventional ...

BACKGROUND: The purpose of this study was to evaluate the correlation between the midterm angiographic results of mammary artery grafts and the preoperative stenosis of the target vessel. METHODS: We analyzed preoperative and postoperative angiograms of 93 patients who underwent postoperative midterm (> or = 3 years) angiograms of an ...

INTRODUCTION: Pleuropulmonary changes are common following coronary artery bypass grafting surgery performed with a saphenous vein graft, with or without an internal mammary artery. The presence of atelectasis or pleural effusions reflects the thoracic trauma. PURPOSE: To define the postoperative incidence of changes in the lung and in the pleural ...

We describe a case of successful direct coronary stenting of two tight lesions, one at the site of the left internal mammary artery (LIMA) graft anastomosis with left anterior descending coronary artery and the other at the site of the anastomosis between the right internal mammary artery (RIMA) graft and ...

Unligated side branches of the left internal mammary artery (LIMA) have been indicated as a cause of coronary steal resulting in postoperative angina. Although a number of studies have reported successful embolization of the side branches to relieve angina, this phenomenon is still controversial and it has been either emphasized ...

The case of a spontaneous dissection of a left internal mammary artery grafted on to the diagonal branch and the left anterior descending artery is reported. The clinical and diagnostic features of this condition are discussed. Despite an extensive literature search, no such case was found. The present case is ...

Arterial grafts are frequently used in modern coronary artery bypass grafting (CABG) and the benefit of the 2 internal mammary arteries (IMA) has already been established. However, the choice of the third arterial conduit, in addition to the IMA, is controversial. We have retrospectively analized perioperative and the follow-up results ...

A case of bilateral coronary ostial aortoarteritis, which presented with angina pectoris, is reported. Emergency total arterial revascularization was performed using the bilateral mammary artery and radial artery, and the radial artery was hanged "Y" on the left internal mammary artery. The patient was discharged on low-dose steroid. He was ...

Redo operations after coronary artery bypass surgery have been on the rise, and myocardial and graft injury during resternotomy a catastrophe. Closure of pericardium after a traditional midline incision may lead to graft distortion. In this report, we will describe a technique of pericardial closure and thymus coverage to protect ...

We describe a patient with inactive systemic lupus erythematosus (SLE) presenting with sudden haemothorax, due to a ruptured internal mammary artery (IMA) aneurysm 7 years after the corticosteroid treatment was terminated. The unusual imaging findings and the treatment with embolization are discussed with a view to the role of a ...

Some different revascularization methods including coronary artery bypass surgery can be performed in the treatment of coronary artery disease. Saphenous vein grafts and/or arterial grafts including left internal mammary artery (LIMA) can be implanted during coronary bypass surgery. It is necessary to perform cannulation of the LIMA, in order to ...

OBJECTIVE: We sought to prospectively evaluate the long-term effect of left internal thoracic artery harvesting on sternal vascularity. METHODS: Twelve consecutive patients undergoing primary coronary artery bypass grafting were studied. In all patients a pedicled left internal thoracic artery was harvested. Each patient underwent a preoperative technetium-99m methylene diphosphonate bone ...

Robotic techniques in coronary surgery have been established for a few years. The preparation of the internal mammary arteries is now a well-described procedure, as is anastomosis to the anterior wall vessels under cardiopulmonary bypass. To achieve totally robotic complete revascularization of the heart, there are still some problems to ...

Situs inversus is a rare condition and there are few reports of myocardial revascularization in such patients. A 56-year-old woman with situs inversus totalis and coronary artery disease underwent successful anastomosis of the right internal mammary artery to the anterior descending coronary artery, and a saphenous vein graft to the ...

BACKGROUND: Coronary artery bypass graft surgery with arterial revascularisation of all diseased coronary vessels is considered highly efficient because arterial grafts have an excellent long-term patency compared with venous grafts. However, problems to reach the infero-lateral wall with the in situ internal thoracic arteries usually require alternative techniques. We present ...

Harvest injury of the internal mammary artery can lead to early thrombosis, which may be difficult to differentiate from atherosclerosis or harvest spasm in some cases. We describe the efficacy of intraoperative evaluation of the internal mammary artery by power Doppler imaging during off-pump or minimally invasive direct coronary artery ...

BACKGROUND: Aortic valve surgery after coronary artery bypass grafting (CABG) in the setting of patent pedicled internal mammary artery (IMA) grafts poses a high risk because of the underlying ischemic and valve disease. Unlike mitral valve surgery or CABG, in which aortic clamping (AoX) may be optional, aortic valve surgery ...

Stenosis at the origin of the left internal mammary artery graft is rare. We present a case with a suspected stenosis involving the origin of the left internal mammary artery that conventional angiography failed to demonstrate convincingly. Intravascular ultrasound illustrated a severe stenosis and the patient underwent successful stenting of ...

To determine the prevalence of Chlamydia pneumoniae DNA in infrequently examined blood vessels. Vessels obtained from 15 men and six women at coronary artery bypass surgery were tested by a nested polymerase chain reaction (PCR) assay for C pneumoniae DNA. Chlamydia pneumoniae DNA was detected in four of six atheromatous ...

BACKGROUND: To evaluate the impact of intramural coronary arteries for the peri-, postoperative and long-term course after arterial switch operation (ASO). METHODS: ASO was performed in 351 patients between 1981 and 2000 with dextrotransposition of the great arteries (d-TGA). Five patients (1.4 %) had an intramural coronary artery. Coronary transfer ...

Coronary artery revascularization remains a feasible and beneficial treatment for coronary artery disease in patients with pseudoxanthoma elasticum. Careful angiographic evaluation of the left internal mammary artery and coronary arteries is required in patients with pseudoxanthoma elasticum with suspected coronary artery disease. A nonstenosed left internal mammary artery at angiography ...

OBJECTIVE: We sought to evaluate whether the radial artery provides the same results as the right internal thoracic artery in lateral wall revascularization in the long term. METHODS: From January 1992 to September 1996, 288 patients had myocardial revascularization with the left internal thoracic artery anastomosed to the left anterior ...

We sought to determine the efficacy of using robotic assistance to facilitate endoscopic harvesting of internal thoracic arteries (ITAs). A total of 104 patients had ITAs harvested endoscopically with use of both the AESOP 3000 system (Computer Motion, Goleta, CA, U.S.A.) and Zeus robotic telesurgical system (Computer Motion). All ITAs ...

Coronary artery bypass grafting (CABG) is one of the most frequently performed operations in the United States. The use of internal mammary artery (IMA) grafting has been identified as increasing the risk of sternal wound infections and mediastinitis. The purpose of our study was to prospectively evaluate the effect of ...

An ostial stenosis of the left internal mammary artery graft anastomosed to the left anterior descending artery was responsible for unstable angina in a patient with a previous coronary artery bypass graft. A T-shape arterectomy was performed between the left subclavian artery and left internal mammary artery. Successful revascularization of ...

BACKGROUND: As off-pump coronary artery bypass grafting (OPCAB) has gained wide attention, the quality of surgical revascularization, which showed favorable initial results, is being frequently questioned. This study was undertaken to assess the midterm outcome of beating-heart coronary anastomosis. METHODS: Seventy-four of 315 patients who underwent beating-heart coronary artery bypass ...

OBJECTIVE: To evaluate radial artery (RA) and internal mammary artery (IMA) grafts in coronary artery bypass and the use of color Doppler ultrasound in the peri-operative evaluation of IMA and radial-ulnar collateral circulation. METHODS: From June 1998 to June 2000, sixty cases of coronary bypass revascularization with RA and IMA ...

OBJECTIVE: This report outlines the procedures and technical aids used for performing thoracoscopic internal mammary artery (IMA) harvesting in a series of 308 patients. METHODS: As a part of atraumatic coronary artery bypass (ACAB) operations, thoracoscopic IMA harvests (294 left, 14 right, and 12 bilateral) were performed in 308 consecutive ...

The "string sign" is a physiological and reversible response of the internal mammary artery (IMA) anastomosed to a moderately stenotic coronary artery. We describe a patient who presented postoperatively with a string sign phenomenon of the right branch of the lambda-composite graft. The graft regained full patency 32 months after ...

We report a case of young male patient who developed left internal mammary artery to pulmonary artery fistula 9 years following the coronary artery bypass grafting operation. The clinical signs and symptoms were very subtle including recurrence of angina and heart murmur. Surgical division of the fistula and re-grafting of ...

The length of the in situ right internal mammary artery (RIMA) often restricts its use as a graft to distal marginal arteries. We describe herein a retrocaval supra-azygous extra-pleural passage of the RIMA that allows a significant gain in length. We report our experience in 30 patients with distal marginal ...

A 15-year-old female patient presented with a history of a mass just medial to the left breast and fever. Her physical examination revealed upper extremity hypertension, delayed and diminished pulsations in the femoral arteries and a midsystolic murmur over the back. On catheterization of the aorta a 45 mmHg systolic ...

BACKGROUND: It has been well established that complete revascularization with internal mammary artery (IMA) grafting is important in young patients undergoing coronary artery bypass grafting (CABG). Applying these principles to octogenarians remains controversial. METHODS: From 1986 to 1999, 358 consecutive patients aged 80 to 94 years underwent CABG. Revascularization was ...

A clinical, prospective trial to evaluate a multi-suture anastomotic device (Heartflo) is currently underway. This new surgical tool can be used during CABG to perform end-to-side or side-to-side coronary arteries anastomoses with interrupted suture technique. This reports our interim preliminary clinical experience. METHODS: From February to November 2000, we attempted ...

BACKGROUND: The aim of this study was to evaluate the outcome and flow dynamics of the lambda graft configuration, relative to a second arterial graft. METHODS: From 1998 to 2000, 47 patients (mean age 55.5 +/- 4.7 years) with triple-vessel disease underwent arterial revascularization using the lambda graft. The in ...

Minimally invasive direct coronary artery bypass usually includes single vessel revascularization via a small skin incision. In most cases, the left internal mammary artery has been used for bypassing to the left anterior descending artery, and only single vessel revascularization used to be performed due to the limited operating field. ...

OBJECTIVE: The application of an endoscopic stabilizer (Intuitive Surgical, Mountain View, CA, USA) enables closed chest off-pump coronary artery bypass via a four-point stab incision avoiding sternotomy and minithoracotomy. METHODS: Between May 1999 and January 2001 we operated upon a total of 37 patients (five female, 32 male, median age ...

Coronary bypass grafts using the internal mammary artery usually have an excellent record of success and long term patency. We report a 42 year old man who initially presented with a history of atypical left sided chest pain, who had coronary artery bypass surgery for a severe stenosis in his ...