True congenital atresia of the left main coronary ostium: delayed presentation

2017 ◽  
Vol 26 (1) ◽  
pp. 54-56 ◽  
Author(s):  
Varadaraju Raju ◽  
Ramesh Chandrashekar Hebbale ◽  
Chandra Sena Muniswamy ◽  
Umesh Sivanna ◽  
Sunil Kumar Kondethimmanahally Rangaiah
Keyword(s):  
Coronary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Delayed Presentation ◽  
Coronary Ostium ◽  
Left Main ◽  
Congenital Atresia ◽  
3 Dimensional ◽  
Dimensional Reconstruction ◽  
Internal Mammary

Congenital atresia of the left main coronary ostium is a rare coronary anomaly presenting in adulthood. A 48-year-old man presented with unstable angina. Coronary angiography showed an absent left coronary ostium with a super-dominant right coronary artery retrogradely filling the left system. Computed tomography-angiography with 3-dimensional reconstruction confirmed the absence of the left main coronary artery. In view of ongoing chest pain, the patient was offered coronary artery bypass surgery. Total arterial revascularization was performed with a left internal mammary artery-left radial artery Y-graft.

scholarly journals Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Jonathan D. Gardner ◽  
William R. Maddox ◽  
Joe B. Calkins
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Rare Complication ◽  
Artery Bypass ◽  
Coronary Vein ◽  
Arteriovenous Fistulas ◽  
Asymptomatic Patients ◽  
Internal Mammary

The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.

Clinical Outcomes after Hybrid Coronary Revascularization versus Off-Pump Coronary Artery Bypass

2009 ◽  
Vol 4 (6) ◽  
pp. 299-306 ◽  
Author(s):  
Thomas A. Vassiliades ◽  
Patrick D. Kilgo ◽  
John S. Douglas ◽  
Vasilis C. Babaliaros ◽  
Peter C. Block ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Internal Mammary Artery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Off Pump ◽  
Internal Mammary ◽  
Hybrid Coronary Revascularization ◽  
Pump Coronary Artery Bypass ◽  
Hybrid Group

Objective Hybrid coronary revascularization is offered as an alternative strategy for patients with multivessel coronary artery disease (CAD). We present our experience and provide a comparative analysis to off-pump coronary artery bypass grafting (OPCAB). Methods Ninety-one patients with multivessel CAD underwent minimally invasive left internal mammary artery to left anterior descending grafting in combination with percutaneous coronary intervention of nonleft anterior descending targets (HYBRID). The primary end point of this study was major adverse cardiac and cerebrovascular events (MACCE), defined as death, stroke, and nonfatal myocardial infarction. MACCE in the HYBRID group were compared with 4175 contemporaneously performed OPCAB operations by logistic (30-day outcomes) and Cox proportional hazards (long-term survival) regression methods. Propensity scoring was used to adjust for potential selection bias. Results The 30-day MACCE (death/stroke/nonfatal myocardial infarction) rate was 1.1% for the HYBRID group (0%/0%/1.1%) and 3.0% for the OPCAB group (1.8%/1.1%/0.5%) (odds ratio = 0.47, P = 0.48). Angiographic left internal mammary artery evaluation was obtained in 95.6% of patients (87 of 91) revealing FitzGibbon A patency in 98.0% (96 of 98). The reintervention rate at 1 year for the HYBRID group was 5.5% (5 of 91) and was limited to repeat percutaneous coronary intervention. Three-year survival was statistically similar for the two groups (hazard ratio = 0.44, P = 0.18, see Kaplan-Meier figure). Conclusions Hybrid coronary revascularization may be noninferior to OPCAB with respect to early MACCE and 3-year survival in the treatment of multivessel CAD.

scholarly journals Refractory Angina Secondary to Large Unligated Side Branch of Internal Mammary Artery

2019 ◽  
Vol 14 ◽  
Author(s):  
Zachary Oman ◽  
Lucas Gu ◽  
Nauman Khalid ◽  
Rahil Rafeedheen ◽  
Hassan Alkhawam ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Medication Management ◽  
Side Branch ◽  
Current Data ◽  
Refractory Angina ◽  
Common Diagnosis ◽  
Internal Mammary

Coronary artery disease (CAD) has become a common diagnosis. Managing the symptoms of CAD continues to be an ongoing dilemma requiring optimal medication management or potential revascularization with either percutaneous coronary interventions or coronary artery bypass grafting (CABG). We present a case of debilitating refractory angina in a patient with severe CAD after optimal medical therapy and CABG secondary to coronary steal phenomenon via the left internal mammary artery conduit supplying a large unligated side branch to the internal chest wall. While current data are inconclusive on this phenomenon, our patient had complete resolution of angina following coil embolization of unligated side branch of the internal mammary artery.   

scholarly journals On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study

2019 ◽  
Vol 35 (3) ◽  
Author(s):  
Muhammad Sher-i-Murtaza ◽  
Mirza Ahmad Raza Baig
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Hemodynamic Instability ◽  
Bypass Grafting ◽  
Operative Strategy ◽  
Internal Mammary

Objective: To evaluate the clinical safety of left internal mammary artery (LIMA) harvesting in hemodynamically unstable patients after establishing cardiopulmonary bypass (CPB) in isolated coronary artery bypass graft (CABG) surgery. Methods: The prospective observational study was conducted at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from December 2016 to August 2018. All patients undergoing isolated CABG surgery in which LIMA conduit was harvested after establishing cardiopulmonary bypass because of hemodynamic instability at induction of anaesthesia or during surgery were included in the study. Preoperative, operative and postoperative characteristics of the patients were recorded. Data was analyzed using SPSS 19. Results: In Forty nine patients including 39 male and 10 female, early CPB had to be established because of hemodynamic instability and afterwards LIMA was harvested. Out of 49, 30 patients presented with CCS class III angina. 37 (75.5%) patients were scheduled on elective coronary surgery waiting list. There were 39 (79.59%) patients who weaned off bypass on mild inotropic support and 4 (8.16%) patients needed IABP support. All patients had multi-vessel coronary artery disease. Mean number of grafts were 3.428±0.577, CPB time was 110.59±25.594 and hospital stay was 5.367±1.424. Conclusions: The study showed that LIMA can be safely harvested in unstable patients after establishing extracorporeal circulation and by using this operative strategy in patients who need urgent or emergent surgical coronary revascularization LIMA can be safely used as a conduit. doi: https://doi.org/10.12669/pjms.35.3.988 How to cite this:Sher-i-Murtaza M, Baig MAR. On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study. Pak J Med Sci. 2019;35(3):---------.  doi: https://doi.org/10.12669/pjms.35.3.988 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Post Coronary Artery Bypass Grafting Failure—Don’t Always Blame the Blues!!

2019 ◽  
Vol 12 ◽  
pp. 117954761982871
Author(s):  
Akshyaya Pradhan ◽  
Vikas Gupta ◽  
Monika Bhandari ◽  
Pravesh Vishwakarma ◽  
Rishi Sethi
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Arterial Grafts ◽  
Artery Bypass Grafting ◽  
Venous Grafts ◽  
Internal Mammary

Long term outcomes following coronary artery bypass grafting are governed by patency of vascular grafts. In this regard, the use of arterial grafts, (preferably the left internal mammary artery) has demonstrated improved survival relative to their venous counterparts. These benefits are a consequence of greater patency of LIMA at 10 years vis-a-vis venous grafts. Uncommonly, there is a possibility of occlusion of LIMA early in the post operative period due to procedural reasons but late occlusion of LIMA is rare. We report an unusual case of late occlusion of LIMA after seven years of CABG.

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