Off-Pump Supraarterial Decompression Myotomy for Myocardial Bridging

2005 ◽  
Vol 8 (1) ◽  
pp. 49 ◽  
Author(s):  
Mersa M. Baryalei ◽  
Theodorus Tirilomis ◽  
Wolfgang Buhre ◽  
Stephan Kazmaier ◽  
Friedrich A. Schoendube ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Exercise Testing ◽  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Median Sternotomy ◽  
Myocardial Bridging ◽  
Off Pump ◽  
Hemodynamic Compromise ◽  
Artery Disease ◽  
The Right

Background: Myocardial bridging of the left anterior descending (LAD) artery may result in clinical symptoms. Surgery with cardiopulmonary bypass (CPB) is a therapeutic option with considerable risk. We hypothesized that off-pump supraarterial myotomy could be an effective treatment modality. Methods: Between October 1998 and May 2000, 13 patients were referred for surgery. All were symptomatic despite medical therapy. Anteroseptal ischemia had been proven by thallium scintigraphy in all 13 patients, exercise testing was positive in 11. All patients were operated on with an off-pump approach after median sternotomy. Results: Mean patient age was 61 8 years (range, 43-71 years). Coronary artery disease mandating additional bypasses was present in 3 patients. The bypasses were done off pump in 2 patients. Conversion to on-pump surgery was necessary in 3 of 13 patients (23%) because of hemodynamic compromise (1 patient), opening of the right ventricle (1 patient), and injury to the LAD (1 patient). Supraarterial myotomy was performed in all patients. One patient who underwent surgery with CPB developed postoperative anteroseptal myocardial infarction. Postoperative exercise testing was performed in all patients and did not reveal any persistent ischemia. Mortality was 0%. All patients were free from symptoms and had not undergone repeat interventions after an average of 51 7 months of follow-up. Conclusions: Off-pump supraarterial myotomy effectively relieves coronary obstruction but has a certain periprocedural risk as evidenced by 1 myocardial infarction, 1 right ventricular injury, and 1 LAD injury. Long-term freedom from symptoms and from reintervention favor further investigation of this surgical therapy.

Off-Pump Coronary Artery Bypass Graft Versus Drug-Eluting Stent Implantation in Patients with Multivessel Disease Involving the Right Coronary Artery

2018 ◽  
Vol 67 (06) ◽  
pp. 458-466
Author(s):  
Jun Ho Lee ◽  
Dong Seop Jeong ◽  
Kiick Sung ◽  
Wook Sung Kim ◽  
Pyo Won Park ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Graft Patency ◽  
Target Vessel ◽  
Off Pump ◽  
Target Vessel Revascularization ◽  
Coronary Territory ◽  
The Right

Abstract Background Whether percutaneous coronary intervention (PCI) is superior to coronary artery bypass grafting (CABG) for the right coronary territory is unknown. The aim of this study was to compare the outcomes and patency in the right coronary territory after CABG or PCI. Methods We studied 2,467 multivessel coronary artery disease patients from January 2001 to December 2011; 1,672 were off-pump CABG patients and 795 were PCI. The graft patency and the presence of major adverse cardiac and cerebrovascular events (MACCEs) including death, myocardial infarction, target vessel revascularization, and stroke were analyzed. Results After propensity score matching, cardiac-related survival was found to be significantly higher in the CABG group than in the PCI group (hazard ratio (HR) for the PCI group: 2.445, p = 0.006). The PCI group showed higher rates of myocardial infarction (HR: 2.571, p = 0.011) and target vessel revascularization (HR: 3.337, p < 0.001). In the right coronary territory, the right internal thoracic artery patency was not different in the PCI group compared with the CABG group (p = 0.248). In CABG group, low right coronary artery graft patency was associated with cardiac-related death (HR: 0.17, p = 0.003) and the occurrence of MACCEs (HR: 0.22, p < 0.001). Conclusion CABG was superior to PCI in patients with multivessel disease. Low graft patency in the right coronary territory was associated with cardiac-related death and the occurrence of MACCEs.

Endovascular trapping of giant serpentine aneurysms by using Guglielmi detachable coils. Successful reduction of mass effect

2001 ◽  
Vol 94 (5) ◽  
pp. 836-840 ◽  
Author(s):  
Goro Otsuka ◽  
Shigeru Miyachi ◽  
Takashi Handa ◽  
Makoto Negoro ◽  
Takeshi Okamoto ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Complex Structure ◽  
Mass Effect ◽  
Collateral Flow ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Effective Therapeutic Option ◽  
Detachable Coils ◽  
The Right

✓ Giant serpentine aneurysms (GSAs) are defined as partially thrombosed giant aneurysms with persistent serpentine vascular channels. Surgical management of these rare lesions is difficult because of their large size, complex structure, and unique hemodynamics. The authors report two cases of patients harboring GSAs with mass effect, which were managed effectively with endovascular treatment. The first patient was a 48-year-old man who presented with left homonymous hemianopsia caused by a GSA involving the terminal portion of the right internal carotid artery. The second patient, a 10-year-old boy, presented with tetraparesis from compression of the cervicomedullary junction by a GSA of the right vertebral artery. In each case, after confirming collateral flow by temporarily occluding the proximal artery, the aneurysm was trapped by placement of Guglielmi detachable coils at the sites at which the serpentine channels entered and exited the aneurysm. The midportion of each channel was isolated completely without packing, to maximize resorption of the devascularized mass. Mass effect and clinical symptoms rapidly improved in both cases, with no associated morbidity. We recommend endovascular trapping as a safe and effective therapeutic option for GSAs.

scholarly journals Multi-Vessel Coronary Artery Disease: Choice of Myocardial Revascularization Strategy

2020 ◽  
Vol 27 (4) ◽  
pp. E202041
Author(s):  
Nestor Seredyuk ◽  
Andrii Matlakh ◽  
Yaroslava Vandzhura ◽  
Mykyta Bielinskyi ◽  
Oleksii Skakun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
The Right

Multi-vessel coronary artery disease is quite a common state, which is often diagnosed by coronary angiography in patients with both stable coronary artery disease and acute coronary syndromes. Major difficulties in percutaneous coronary intervention include stent thrombosis and the need for antiplatelet therapy (aspirin and a P2Y12 inhibitor). Stent thrombosis leads to the recurrence of myocardial infarction and may occur within the first few hours after percutaneous coronary intervention. The use of dual antiplatelet therapy, especially that combined with low-molecular-weight heparin in the first days after myocardial infarction, poses a risk of bleeding, which often occurs in real clinical practice. Among P2Y12  inhibitors, ticagrelor causes bleeding somewhat more frequently than clopidogrel. A case of multi-vessel coronary artery disease is described in this paper. Coronary angiography revealed right-dominant circulation; occlusion of the proximal and medial segments of the right coronary artery, thrombolysis in myocardial infarction flow grade 0; stenosis of the left main coronary artery (50-60%), thrombolysis in myocardial infarction flow grade 2; diffuse stenosis of the medial and distal segments of the left anterior descending artery, thrombolysis in myocardial infarction flow grade 1; stenosis of the proximal segment of the left circumflex artery (> 75%), thrombolysis in myocardial infarction flow grade 1. The patient underwent percutaneous coronary intervention; the stents were implanted in the infarct-dependent right coronary artery. The clinical course was complicated by early stent thrombosis with subsequent thrombus extraction; a day later melena developed. Bleeding was stopped, the intensity of antithrombotic therapy was reduced: the combination of aspirin and ticagrelor was replaced by the combination of aspirin and clopidogrel. Six weeks after stenting of the infarct-dependent coronary artery, complete myocardial revascularization (hybrid intervention) was performed: coronary artery bypass grafting [the left internal mammary artery → the left anterior descending artery], coronary autogenous bypass grafting [the aorta → the right coronary artery and the aorta → the left circumflex artery]. The role of fractional flow reserve or instantaneous wave-free ratio-controlled complete myocardial revascularization techniques is discussed. The following algorithm for myocardial revascularization was used: percutaneous coronary intervention for the right coronary artery + coronary artery bypass grafting-3: the left internal mammary artery → the left anterior descending artery, the aorta → the left circumflex artery, the aorta → the right coronary artery.

Heparin-induced thrombocytopenia in cardiac surgery and critically ill patients

2016 ◽  
Vol 116 (11) ◽  
pp. 843-851 ◽  
Author(s):  
Sixten Selleng ◽  
Kathleen Selleng
Keyword(s):  
Cardiac Surgery ◽  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Thrombin Inhibitors ◽  
Ventricular Assist Devices ◽  
Direct Thrombin Inhibitors ◽  
Impaired Liver Function ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
Off Pump

SummaryThrombocytopenia as well as anti-platelet factor 4/heparin (PF4/H) antibodies are common in cardiac surgery patients and those treated in the intensive care unit. In contrast, heparin-induced thrombocytopenia (HIT) is uncommon in these populations (∼1 % and ∼0.5 %, respectively). A stepwise approach where testing for anti-PF4/H antibodies is performed only in patients with typical clinical symptoms of HIT improves diagnostic specificity of the laboratory assays without losing sensitivity, thereby helping to avoid overdiagnosis and resulting HIT overtreatment. Short-term re-exposure to heparin, especially given intraoperatively for cardiovascular surgery, is a reasonable therapeutic option in patients with a history of HIT who subsequently test negative for HIT antibodies. Organ failure(s), enhanced bleeding risks, and other characteristics require special considerations regarding non-heparin anticoagulation: Argatroban is the alternative anticoagulant with pharmacokinetics independent of renal function, but it has a prolonged half-life in case of impaired liver function. For bivalirudin, protocols during cardiopulmonary bypass surgery are established, and it is suitable for patients with liver insufficiency. A major issue of direct thrombin inhibitors are false high activated partial thromboplastin time values in patients with comorbidities affecting prothrombin, which can result in systematic underdosing of the drugs. This is not the case for danaparoid and fondaparinux, which can be monitored by anti-factor Xa assays, but have long half-lives and no suitable antidote. This review includes also information on management of on- and off-pump cardiac surgery, ventricular assist devices, percutaneous interventions, continuous renal replacement therapy, and extracorporeal membrane oxygenation in patients with HIT.

Anomalous Origin of Right Coronary Artery From Left Coronary Sinus—13 Cases Treated With the Reimplantation Technique

2017 ◽  
Vol 8 (3) ◽  
pp. 315-320 ◽  
Author(s):  
Alain Cubero ◽  
Alejandro Crespo ◽  
Gadah Hamzeh ◽  
Andrés Cortes ◽  
Daniel Rivas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Anomalous Origin ◽  
Atypical Chest Pain ◽  
Asymptomatic Patients ◽  
Clinically Significant ◽  
Artery Disease ◽  
The Right

Objectives: Anomalous aortic origin of a coronary artery is uncommon but potentially clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe our experience with surgical reimplantation and results at midterm follow-up. Methods: Between February 2003 and July 2016, a total of 13 patients with anomalous origin of the right coronary artery (RCA) from the left sinus underwent surgical reimplantation. Results: Mean age was 39 years (range, 11-72 years). Eight patients presented with dyspnea and angina, two with acute myocardial infarction, and the remaining three were studied for atypical chest pain and ventricular premature contractions. Definitive diagnosis was achieved with coronary angiography in eight cases and with computed tomography scan in five. In all cases, the anomalous origin of the RCA from the left sinus had an intramural course except one case with interarterial (but not intramural) course. At operation, the RCA was dissected at the takeoff from the intramural course and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated atherosclerotic coronary artery disease that required stent placement postoperatively. After a mean follow-up of 65 months (maximum 12 years), all patients are asymptomatic and have returned to exercise without limitations. Conclusions: The reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives similar results to the unroofing technique.

scholarly journals Takotsubo Cardiomyopathy in Two Patients without Any Cardiac Symptom on Maintenance Hemodialysis

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Jun Muratsu ◽  
Atsuyuki Morishima ◽  
Hiroyasu Ueda ◽  
Hisatoyo Hiraoka ◽  
Katsuhiko Sakaguchi
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Takotsubo Cardiomyopathy ◽  
Clinical Symptoms ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
Cardiac Symptom ◽  
Electrocardiographic Changes ◽  
Artery Disease

Takotsubo cardiomyopathy is a disorder characterized by left ventricular apical ballooning and electrocardiographic changes in the absence of coronary artery disease. While reversible in many cases, the mechanism of this disorder remains unclear. The most frequent clinical symptoms of takotsubo cardiomyopathy on admission are chest pain and dyspnea, resembling acute myocardial infarction. Here, we describe two cases of takotsubo cardiomyopathy without chest pain or dyspnea in patients on maintenance hemodialysis. The asymptomatic nature of these two cases may be due to the patients being on hemodialysis. Periodic electrocardiograms (ECG) may be helpful in screening this population for asymptomatic takotsubo cardiomyopathy and in evaluating its incidence.

Peripheral thrombosis causing simultaneous saddle pulmonary embolism and paradoxical ST elevation myocardial infarction resulting in cardiovascular collapse

2021 ◽  
Vol 14 (4) ◽  
pp. e240312
Author(s):  
Hafiz Ghafoor ◽  
Nitish Kumar Sharma ◽  
Zeba Hashmath ◽  
Eddison Ramsaran
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Coronary Artery ◽  
Main Pulmonary Artery ◽  
Transoesophageal Echocardiography ◽  
St Segment Elevation ◽  
Artery Embolism ◽  
Coronary Artery Embolism ◽  
Artery Disease ◽  
The Right

Paradoxical coronary artery embolism is often an underdiagnosed cause of acute myocardial infarction (MI). It should always be considered in patient with acute MI and a low risk profile for atherosclerotic coronary artery disease. We describe a patient with simultaneous acute saddle pulmonary embolism (PE) and acute ST segment elevation MI due to paradoxical coronary artery embolism. Transoesophageal echocardiography demonstrated a patent foramen ovale with right to left shunt and large saddle PE in the main pulmonary artery and coronary angiography demonstrated acute thrombotic occlusion of the right coronary artery.

Cardiac death by rupture of the right ventricular wall and hemopericardium

Open Medicine ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. 45-48 ◽  
Author(s):  
Francesco Massoni ◽  
Serafino Ricci
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Right Ventricular ◽  
Cardiac Death ◽  
Ventricular Wall ◽  
Free Wall ◽  
Autopsy Case ◽  
Right Ventricular Wall ◽  
Artery Disease ◽  
The Right

AbstractRight Ventricular (RV) rupture is a rare and dangerous complication of acute myocardial infarction. There are limited reports on RV free wall rupture. In this paper we describe the outcome of an autopsy case of cardiac death by rupture of the free wall of the right ventricle in a 51-year-old man with coronary artery disease and hypertrophic-sclerotic cardiomyopathy.

scholarly journals T-Bar Utilization for Concomitant Coronary Artery Bypass Graft Operation and Left Upper Lobectomy

2016 ◽  
Vol 2016 ◽  
pp. 1-2 ◽  
Author(s):  
Fotios Mitropoulos ◽  
Meletios A. Kanakis ◽  
Anastasios Apostolou ◽  
Andrew Chatzis ◽  
Constantinos Contrafouris ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Lung Resection ◽  
Bypass Graft ◽  
Tumor Resection ◽  
Median Sternotomy ◽  
Off Pump ◽  
Artery Disease ◽  
Pump Coronary Artery Bypass

Management in patients with coexisting coronary artery disease and lung carcinoma is usually a two-stage operation, with the cardiac surgery procedure followed by pulmonary resection at a later time. Delayed tumor resection on the other hand may be detrimental. Off-pump coronary artery bypass grafting could facilitate concomitant lung resection at one stage via median sternotomy. T-bar retractor may be a useful tool in the surgical approach of this combined operation.

scholarly journals Intra-cardiac cement embolism during hip arthroplasty

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Alexander Amir ◽  
◽  
David Bracco ◽  
Gabriele Baldini ◽  
André Denault ◽  
...  
Keyword(s):  
Treatment Options ◽  
Coronary Bypass ◽  
Aortic Valve Area ◽  
Hemodynamic Compromise ◽  
Neck Fracture ◽  
Cement Embolism ◽  
History Of ◽  
Artery Disease ◽  
The Right ◽  
Hemi Arthroplasty

A 92-year-old woman presented to the operating room with a right femoral neck fracture. She had a past medical history significant for atrial fibrillation, coronary artery disease with a history of coronary bypass, severely stenotic aortic valve (area 0.9 cm2), diabetes, dyslipidemia, hypertension and dementia. She underwent general anesthesia with continuous Transesophageal Echocardiographic (TEE) monitoring for a right hemi-arthroplasty. While cementing the prosthesis, small cement emboli were initially seen (ME ascending aorta SAX view) migrating in the pulmonary artery (Figure A*). Subsequently, a large (4 cm) cement embolus was visualized in the right atrium, adhered to the Eustachian valve, an embryonic remnant (Figure B*, supplementary video A). The patient experienced no significant hemodynamic compromise or issue with gas exchange. Given embolization risk and severe potential for harm, intervention may be indicated. Treatment options were discussed but given hemodynamic stability, patient age and comorbidities, the patient was monitored without further intervention.

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