Outcomes of Radial Artery Grafts Without Postoperative Calcium Channel Blocker Administration

Background: Guidelines encourage oral pharmacologic antispasmodic therapy for patients receiving a radial artery conduit during coronary artery bypass grafting. We review our experience with radial artery conduits without the postoperative use of calcium channel blocker therapy. Methods: A single-center, retrospective review patients undergoing isolated coronary artery bypass grafting with at least one radial artery conduit over a three-year period was performed. Patient demographic, operative, and post-discharge data were collected. Development of angina or angina equivalent symptoms, imaging suggestive of radial conduit failure, or percutaneous intervention to the territory grafted by a radial artery was considered to represent graft failure. Patients were evaluated for primary outcomes through 90 days postoperatively and followed for 1 year overall. Results: 264 adult patients underwent first-time, isolated coronary artery bypass grafting with use of a radial artery conduit. Three patients were observed to have radial graft occlusions during the first 90 days, all of which were attributed to technical issues. No patients required addition of a calcium channel blocker & no additional patients underwent imaging or intervention for radial graft failure during 1 year of follow up. Conclusions: Avoidance of postoperative calcium channel blocker therapy in patients receiving a radial artery graft was not associated with a high incidence of imaging-confirmed or clinically suggested conduit failure.

Twin Root Replacement in Congenital Heart Disease: Expert Technique

In adult congenital heart disease, there are situations that require both the aortic and pulmonary roots to be replaced at the time of a reoperation. This commonly involves the replacement of a previously implanted right ventricle-pulmonary artery conduit in a patient with late aortic root dilation and/or neo-aortic valve dysfunction following the Ross procedure. Similar scenarios are encountered in patients having undergone previous repair of conotruncal anomalies such as truncus arteriosus and tetralogy of Fallot with pulmonary atresia. We describe our standardized technique for twin root replacement.

Acyanotic Truncus Arteriosus: Not a Misnomer But a True Rarity

Truncus arteriosus, also referred to as common arterial trunk (CAT), is generally classified as a cyanotic congenital heart disease characterized by a single arterial trunk arising from the heart and supplying both pulmonary and systemic circulations. Cyanosis exists by virtue of it being an admixture lesion. We report a 13-year-old boy diagnosed to have type 1 CAT who was acyanotic at presentation and had all features of an operable lesion even at this age. He underwent a successful repair with closure of the subtruncal VSD and insertion of a hand-sewn valved right ventricle-to-pulmonary artery conduit made of bovine pericardium and Gore-Tex membrane.

Alternative Uses of the Ozaki Technique: Aortic Valved Conduit in a Bentall Operation and Right Ventricle-to-Pulmonary Artery Conduit

The modified Ozaki technique within a conduit is reproducible and is an alternative to the use of homografts and commercially available conduits which may have special appeal in a low resource setting.

Chronic intercostal neuralgia after placement of right ventricle to pulmonary artery conduit with prosthetic valve

Adults with congenital heart disease often have complex medical issues requiring individualised multidisciplinary care for optimising outcomes and quality of life. Chronic pain is an example. We report a rare case of intercostal neuralgia seemingly caused by irritation from a prosthetic valve in a right ventricle to pulmonary artery conduit in a patient with tetralogy of Fallot. Intercostal neuralgia is a painful disorder linked to nerve irritation or injury from trauma, infection or pressure. Although chronic postsurgical pain after cardiac surgery is prevalent, rarely the aetiology relates to valve irritation on a single intercostal nerve. After failing pharmacological therapy for 8 months, the neuralgia completely resolved after an ultrasound-guided neurolytic block with long-term effectiveness and improvement in patient satisfaction.