Expanded Use of the Right and Left Internal Mammary Arteries for Myocardial Revascularization

1988 ◽  
Vol 36 (04) ◽  
pp. 194-197 ◽  
Author(s):  
R. Rivera ◽  
E. Duran ◽  
M. Ajuria
Keyword(s):  
Myocardial Revascularization ◽  
Mammary Arteries ◽  
Internal Mammary ◽  
The Right

scholarly journals Total arterial myocardial revascularization using bilateral internal mammary arteries and the role of postoperative sternal stabilization to reduce wound infections in a large cohort study

2019 ◽  
Vol 29 (2) ◽  
pp. 224-229 ◽  
Author(s):  
Marc Albert ◽  
Ragi Nagib ◽  
Adrian Ursulescu ◽  
Ulrich F W Franke
Keyword(s):  
Retrospective Study ◽  
Wound Infection ◽  
Internal Mammary Artery ◽  
Wound Closure ◽  
Myocardial Revascularization ◽  
Wound Complications ◽  
Wound Infections ◽  
Term Survival ◽  
Mammary Arteries ◽  
Internal Mammary

Abstract OBJECTIVES Total arterial myocardial revascularization using bilateral internal mammary arteries shows improved results for mortality, long-term survival and superior graft patency. It has become the standard technique according to recent guidelines. However, these patients may have an increased risk of developing sternal wound infections, especially obese patients or those with diabetes. One reason for the wound complications may be early sternum instability. This situation could be avoided by using a thorax support vest (e.g. Posthorax® vest). This retrospective study compared the wound complications after bilateral internal mammary artery grafting including the use of a Posthorax vest. METHODS Between April 2015 and May 2017, 1613 patients received total arterial myocardial revascularization using bilateral internal mammary artery via a median sternotomy. The Posthorax support vest was used from the second postoperative day. We compared those patients with 1667 patients operated on via the same access in the preceding 26 months. The end points were the incidence of wound infections, when the wound infection occurred and how many wound revisions were needed until wound closure. RESULTS The demographic data of both groups were similar. A significant advantage for the use of a thorax support vest could be seen regarding the incidence of wound infections (P = 0.036) and the length of hospital stay when a wound complication did occur (P = 0.018). CONCLUSIONS As seen in this retrospective study, the early perioperative use of a thorax stabilization vest, such as the Posthorax vest, can reduce the incidence of sternal wound complications significantly. Furthermore, when a wound infection occurred, and the patient returned to the hospital for wound revision, patients who were given the Posthorax vest postoperatively had a significantly shorter length of stay until wound closure.

scholarly journals Different effects of activated platelets in the right gastroepiploic and internal mammary arteries

1992 ◽  
Vol 104 (5) ◽  
pp. 1294-1302 ◽  
Author(s):  
Xin-Nong Li ◽  
Peter Stulz ◽  
Robert P. Siebenmann ◽  
Zhihong Yang ◽  
Thomas F. Lüscher
Keyword(s):  
Activated Platelets ◽  
Mammary Arteries ◽  
Internal Mammary ◽  
The Right

Routine use of bilateral skeletonized internal mammary arteries for myocardial revascularization

1999 ◽  
Vol 68 (2) ◽  
pp. 406-411 ◽  
Author(s):  
Jacob Gurevitch ◽  
Yosef Paz ◽  
Itzhak Shapira ◽  
Menachem Matsa ◽  
Amir Kramer ◽  
...  
Keyword(s):  
Myocardial Revascularization ◽  
Mammary Arteries ◽  
Internal Mammary

Single-stage open repair of severe asymmetric pectus excavatum and mitral valve replacement in connective tissue disease

2021 ◽  
pp. 021849232110140
Author(s):  
Cheong Ping Pau ◽  
Kee Soon Chong ◽  
Mohd Azhari Yakub ◽  
Alizan Abdul Khalil
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Pectus Excavatum ◽  
Pedicled Flap ◽  
Single Stage ◽  
Left Hemithorax ◽  
Mammary Arteries ◽  
Internal Mammary ◽  
The Right

We present a 14-year-old boy with Loey–Dietz syndrome with severe mitral regurgitation, pectus excavatum and scoliosis. The Haller index was 25. The heart was displaced into the left hemithorax. The right inferior pulmonary vein was very close to the sternum and vertebral body. Single-stage surgery was performed. An osseo-myo-cutaneous pedicled flap was created by sterno-manubrial junction dislocation and rib resection with bilateral internal mammary arteries supplying the flap. Cardiopulmonary bypass and mitral valve replacement was performed. The defect was bridged with three straight plates. The flap was laid on top and anchored. Early outcome at three months was good.

scholarly journals 324 Unilateral pulmonary artery agenesis with controlateral embolism: a double vascular trouble

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandro Pierri ◽  
Antonio De Luca ◽  
Luca Restivo ◽  
Alessandro Bologna ◽  
Angela Poletti ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Pulmonary Artery ◽  
Myocardial Revascularization ◽  
Ipsilateral Lung ◽  
Vein Segment ◽  
Internal Mammary ◽  
The Right ◽  
Unilateral Pulmonary Artery Agenesis ◽  
Pulmonary Artery Agenesis

Abstract Methods and results A 60-year-old male patient underwent coronary angiography (CA) for a non-ST segment elevation myocardial infarction (NSTEMI). CA revealed significant multivessel disease. Both internal mammary arteries (AMI) were patent, with right IMA markedly larger than the left IMA. The exam revealed also an abnormal branch arising from the proximal right coronary artery extending backwards, likely to the right lung. Pre-operative chest radiograph demonstrated asymmetry of the two hemithoraces with slight elevation of the right hemidiaphragm, small ipsilateral lung, and mediastinal shift towards the right. The patient underwent urgent CABG surgery. Myocardial revascularization was successfully performed using both AMI and one saphenous vein segment. The postoperative course was complicated by respiratory failure requiring prolonged mechanical ventilation. A chest computed tomography angiography was performed, revealing complete absence of the right pulmonary artery and a left lower lobe segmental pulmonary embolism. Furthermore, blood in the hypoplastic right lung was supplied by multiple collaterals arising from RCA and right IMA. Intravenous heparin was started with clinical improvement. Two weeks later, a lung scintigraphy was performed, ruling out perfusion defects. The patient was discharged home on oral anticoagulation with warfarin. Conclusions Unilateral pulmonary artery agenesis (UPAA) is an uncommon congenital anomaly of the great vessels. Despite the absence of the pulmonary artery, blood supply of ipsilateral lung is provided by systemic collaterals originating from bronchial, intercostal, internal mammary, and sub-diaphragmatic arteries. More rarely, these collaterals may arise from the coronary arteries with different implications, ranging from asymptomatic condition to myocardial ischaemia and infarction. In our case, the condition was previously asymptomatic. The occurrence of pulmonary embolism contributed to worsen the ventilation–perfusion mismatch, explaining the respiratory failure during the postoperative period.

Experiences with Myocardial Revascularization By Division of the Internal Mammary Arteries

1958 ◽  
Vol 33 (6) ◽  
pp. 637-657 ◽  
Author(s):  
RCBERT P. GLOVER ◽  
J. RODERICK KITCHELL ◽  
ROBERT H. KYLE ◽  
JULIO C. DAVILA ◽  
ROBERT G. TROUT
Keyword(s):  
Myocardial Revascularization ◽  
Mammary Arteries ◽  
Internal Mammary

Myocardial Revascularization with Multiple Arterial Grafts

1995 ◽  
Vol 3 (3-4) ◽  
pp. 95-102 ◽  
Author(s):  
Antonio Maria Calafiore ◽  
Gabriele Di Giammarco ◽  
Giovanni Teodori ◽  
Shree Prakash Mall ◽  
Giuseppe Vitolla ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Main Trunk ◽  
Arterial Grafts ◽  
Ventricular Ejection Fraction ◽  
Early Results ◽  
Mammary Arteries ◽  
Internal Mammary

From October 1991 10 July 1994, 439 patients underwent elective or urgent coronary artery bypass grafting utilizing 2 or more arterial conduits. Age ranged from 28 to 79 years (mean, 62.3 years). Most of the patients had 3-vessel disease (301); the remaining had 2-vessel (120) or 1-vessel (18) disease. A stenosis of the left main trunk greater than or equal to 50% was present in 73 patients; in 16 cases it was a redo operation. The left ventricular ejection fraction ranged from 0.19 to 0.84 (mean, 0.53). We utilized 1110 arterial conduits (430 left internal mammary arteries, 259 right internal mammary arteries, 136 right gastroepiploic arteries, 120 inferior epigastric arteries, 165 radial arteries) together with 113 saphenous veins (2.63 arterial anastomoses per patient, ranging from 2 to 6). In 347 patients (79%) we performed a complete arterial myocardial revascularization with an average of 2.80 anastomoses per patient. Two arterial conduits were used in 245 patients, 3 in 163, 4 in 30, and 5 in 1 patient. The myocardial protection was achieved by means of intermittent antegrade warm blood cardioplegia. The mean cross-clamping time was 47.3 ± 16 minutes (range, 16 to 142 minutes). Five patients (1.1%) died in the postoperative period, none were in the operating theater. The causes of death were cardiac (2), sepsis (1), pneumonia (1) and pancreatic necrosis (1). In 7 patients (1.6%) a perioperative myocardial necrosis occurred without any hemodynamic sequelae. Out of 430 patients alive, 419 (97.4%) are asymptomatic. At the postoperative angiographic control all the arterial grafts explored showed complete patency; the midterm angiography (mean, 14 months) revealed a cumulative patency of 96% (range, 100% for the left internal thoracic artery to 94.1% for the radial artery). We conclude that on the basis of the early results the technique herein described is effective and reproducible, even if long-term follow-up is needed to confirm these data.

Right Gastroepiploic Artery in Myocardial Revascularization: Portuguese Experience

1995 ◽  
Vol 3 (2) ◽  
pp. 71-74
Author(s):  
José Roquette ◽  
Jorge Ouininha ◽  
Nelson Castelão ◽  
Filipe Robalo ◽  
Duarte Serra e Melo ◽  
...  
Keyword(s):  
Internal Mammary Artery ◽  
Myocardial Revascularization ◽  
Gastroepiploic Artery ◽  
Inferior Wall ◽  
Perioperative Myocardial Infarction ◽  
Arterial Revascularization ◽  
Right Gastroepiploic Artery ◽  
Internal Mammary ◽  
The Right

Excellent results obtained with the use of the internal mammary artery in myocardial revascularization led us to complement its use with other arterial conduits, and the right gastroepiploic artery (RGEA) emerged as a valid alternative, allowing the expansion of total arterial revascularization. From July 1988 until September 1994 we utilized the RGEA in 101 patients with ages between 30 and 71 years (mean 54 9.43). The RGEA was used to bypass the posterior descending artery in 90 patients and for the marginal branches of the circumflex in 11. Exclusive arterial revascularization was possible in 92% of the cases with a mean of 2.7 bypasses per patient. There were 4 (4%) cases of death, and 3 instances of perioperative myocardial infarction. Angiographic control of the RGEA performed in 46 patients showed a patency of 87%. In conclusion, the RGEA was predominantly used to revascularize the inferior wall of the myocardium as a complement to the internal mammary artery. Its use occurred without significant morbidity and mortality, and postoperative angiographic visualization of these arterial conduits allowed us to expect good mid-and long-term patency.

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