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ATHEROSCLEROSIS OF THE INTERNAL MAMMARY ARTERY IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING
M. Essalat,S.H. Mirkhani,M. Ghasemi,M. Zarezadeh
Acta Medica Iranica , 2003,
Abstract: In patients requiring coronary artery bypass grafting (CABG), usually at least one of the internal mammary arteries is used. This study evaluates the degree of atherosclerotic involvement of the internal mammary artery (IMA) in patients undergoing CABG. During two months period, 79 patients (66 male and 13 female with a medium age of 58 years) undergoing myocardial revascularization had a biopsy of the distal left internal mammary artery. In our study atherosclerotic involvement of the IMA was assessed according to the scale of Kay. Using this index, grade 0 corresponds to a normal artery without atherosclerosis, grade 1 represents minimal disease, grade 2 a narrowing of less than 25% of the lumen, grade 3 narrowing between 25 and 50%, and grade 4 narrowing of 50% or greater of the lumen. Of the 79 IMAs examined, the arteries with degree 0, 1, 2, 3, and 4 were: 17 (21.5%), 36 (45.6%), 13 (16.5%), 10 (12.7%), and 3 (3.8%), respectively. Considering the arteries with severe atherosclerotic narrowing (3.8%), the IMA had a low but consistent incidence of atherosclerotic involvement. According to our investigation among risk factors only high blood pressure has some roles in inducing atherosclerotic changes (p=0.014). The other risk factors (i.e. diabetes mellitus, smoking, hyperlipidemia) had no correlation with the atherosclerotic changes in IMA. Preoperative angiography of the IMA is not necessary for all the patients that require CABG, but could be recommended in hypertensive patients.
Internal mammary artery steal syndrome secondary to a para-IMA after coronary artery bypass graft: a case report
Internal mammary artery steal syndrome secondary to a para-IMA after coronary artery bypass graft: a case report

Jie Gao,Pi-Xiong Su,Yan Liu,
Jie Gao
,Pi-Xiong Su,Yan Liu

老年心脏病学杂志(英文版) , 2009,
Abstract: Introduction The use of the internal mammary artery (IMA) in coronary artery bypass graft(CABG) for myocardial revascularization is gaining popularity in routine practice,especially when the target vessel is the left anterior descending artery (LAD).Occasionally,IMA hypoperfusion occurs when there is inadequate flow through the IMA graft to the LAD artery due to the exist of lateral branches.4,5 The graft hypoperfusion can occur both acutely and chronically resulting inmaiperfusion syndrome and dysfunctional graft with persistent ischemia in the region of supply.
The radial artery for coronary artery bypass grafting  [PDF]
Ne?i? D.,Milojevi? P.,?irkovi? M.,Kne?evi? A.
Acta Chirurgica Iugoslavica , 2005, DOI: 10.2298/aci0503011n
Abstract: Coronary artery bypass grafting (CABG) is the standard surgical procedure for the treatment of advanced coronary artery disease. CABG surgery has been demonstrated to improve symptoms and, in specific subgroups of patients, to prolong life. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. Previous long-term studies have shown unsatisfactory patency of saphenous vein grafts used for myocardial revascularisation, compared with internal mammary artery grafts. Recently, the use of radial artery for CABG has enjoyed a revival, on the basis of the belief that it will help improving long-term results of coronary operations. The recent reports of encouraging mid-term and long-term patency rates of the radial artery, supports its continued use as a bypass conduit. In this paper, we review the current knowledge about the radial artery as a bypass graft, with special emphasis on the clinical results.
Aortic distensibility and coronary artery bypass graft patency
Bülent ?zdemir, Murat Bi?er, Levent ?zdemir, ?brahim Baran, Aysel Kaderli, Tunay ?entürk, Ali Emül, Zeynel Yetgin, Sümeyye Güllülü, Ali Ayd?nlar
Journal of Cardiothoracic Surgery , 2009, DOI: 10.1186/1749-8090-4-14
Abstract: The study was conducted in the Cardiology department of the Applied Research Centre for Health of Uluda? University. The coronary angiograms of 53 consecutive coronary bypass patients were analysed retrospectively. Aortic distensibility was calculated using the formula: 2 × (change in aortic diameter)/(diastolic aortic diameter) × (change in aortic pressure). The number of stenosed and patent bypass grafts and the patient characteristics like age, risk factors were noted.There were 44 male (83%) and 9 female (17%) cases. Eighteen cases had only one saphenous vein grafting. The number of cases with two, three and four saphenous grafting were 18, 11 and 1; respectively. In the control angiograms the number of cases with one, two, three and four saphenous vein graft obstruction were 15 (31.3%), 7 (14.6%), 1 (2.1%) and 1 (2.1%) respectively. The aortic distensibility did not differ in cases with and without saphenous graft occlusion (p > 0.05). Also left internal mammary artery (LIMA) graft patency was not related to the distensibility of the aorta (p > 0.05). We also evaluated the data for cut-off values of 50 and 70 mmHg of pulse pressure and did not see any significant difference between the groups in terms of saphenous or LIMA grafts.In this study we failed to show association of angiographically determined aortic distensibility with coronary bypass graft patency in consecutive 53 patients with coronary artery bypass graft surgery (CABG).The long-term patency of the arterial and venous grafts determines the success of coronary artery bypass grafting. Most of the decrease in patency of arterial grafts is associated with moderate stenosis of the native coronary artery and most of the decrease in patency of vein grafts was associated with graft disease itself [1]. Immediate postoperative graft failure may happen and the long-term patency of the saphenous vein graft may be affected by fibro-intimal hyperplasia during the first year after surgery and by atherosclerosis b
Internal Mammary to Pulmonary Artery Fistula Presenting as Early Recurrent Angina after Coronary Bypass
Ferreira, Alexandre C.;Marchena, Eduardo de;Liester, Michelle;Sangosanya, Afolabi O.;
Arquivos Brasileiros de Cardiologia , 2002, DOI: 10.1590/S0066-782X2002001100010
Abstract: 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 patient's angina and abnormal stress nuclear study were due to coronary steal. in patients with a history of coronary bypass grafting, fistula formation between graft and native vessels should be considered as a possible cause of early recurrent angina.
Internal Mammary to Pulmonary Artery Fistula Presenting as Early Recurrent Angina after Coronary Bypass  [cached]
Ferreira Alexandre C.,Marchena Eduardo de,Liester Michelle,Sangosanya Afolabi O.
Arquivos Brasileiros de Cardiologia , 2002,
Abstract: 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 patient's angina and abnormal stress nuclear study were due to coronary steal. In patients with a history of coronary bypass grafting, fistula formation between graft and native vessels should be considered as a possible cause of early recurrent angina.
Triple Vessel Coronary Artery Bypass Grafting in a 14-year-old Child with Familial Hypercholesterolemia-A Rare Case Report
S Borkar Shirish, S Ganesh Kamath, Sagar C.V. Sunil, Bedjirgi Chidanand and Kashyap Nitin
Open Journal of Cardiovascular Surgery , 2012,
Abstract: Familial hypercholesterolemia is a genetic disorder caused by a mutation in the low density lipoprotein (LDL) receptor gene. The homozygous type of the disease is rare and causes tendon xanthomas and coronary artery disease during the early years of life. Premature coronary artery occlusive disease in familial homozygous hypercholesterolemia might necessitate coronary bypass surgery in children and young adults We present the case of a 14-year-old boy with familial hypercholesterolemia and coronary artery disease. He underwent triple-vessel coronary artery bypass grafting with bilateral pedicled internal mammary artery and saphenous vein grafting without adverse events. Pediatric patients with familial hypercholesterolemia may present with premature coronary atherosclerosis requiring coronary artery bypass grafting. In situ internal mammary artery grafts should be the graft of choice. To the best of our knowledge, he is one of the youngest such patients reported in the English-language literature who underwent coronary artery bypass surgery.
Bilateral versus Single Internal Mammary Coronary Artery Bypass Grafting in Sweden from 1997–2008  [PDF]
Magnus Dalén, Torbj?rn Ivert, Martin J. Holzmann, Ulrik Sartipy
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0086929
Abstract: Background Prior observational studies have suggested better outcomes in patients who receive bilateral internal mammary arteries (BIMA) during coronary artery bypass grafting (CABG) compared with patients who receive a single internal mammary artery (SIMA). The aim of this study was to analyze the association between BIMA use and long-term survival in patients who underwent primary isolated CABG. Methods and Results Patients who underwent primary isolated non-emergent CABG in Sweden between 1997 and 2008 were identified. The SWEDEHEART registry and other national Swedish registers were used to acquire information about patient characteristics and outcomes. Unadjusted and multivariable adjusted regression models were used to estimate the association between BIMA use and early mortality, long-term survival, and a composite of death from any cause or rehospitalization for myocardial infarction, heart failure, or stroke in the overall cohort and in a propensity score-matched cohort. The study population consisted of 49702 patients who underwent CABG with at least one internal mammary artery, and 559 (1%) of those had BIMA grafting. In the adjusted analyses, BIMA use was not associated with better survival compared with SIMA use in the overall cohort (hazard ratio (HR) for death: 1.16, 95% confidence interval (CI): 0.97 to 1.37) or in the matched cohort (HR: 1.04, 95% CI: 0.78 to 1.40). The results were similar for early mortality and the composite endpoint. Reoperation for sternal wound complications was more common among BIMA patients (odds ratio: 1.71, 95% CI: 1.01 to 2.88). Conclusions BIMA grafting was performed infrequently and was not associated with better outcomes compared with SIMA grafting in patients undergoing non-emergent primary isolated CABG in Sweden during 1997–2008.
In situ pedicle graft and coronary-coronary bypass grafting using internal thoracic artery in management of multiple lesions of the left anterior descending coronary artery
Ne?i? Du?ko G.,Kne?evi? Aleksandar M.,?irkovi? Milan V.,Jovi? Miomir ?.
Medicinski Pregled , 2004, DOI: 10.2298/mpns0412601n
Abstract: Introduction Nowadays, coronary-coronary bypass grafting (CCBG) has been applied in patients with heavily calcified ascending aorta or due to lack of graft material. Case report We describe a case in which the patient's large left anterior descending (LAD) coronary artery, running well over the cardiac apex, presented with proximal and distal stenosis. Although the pedicled left internal thoracic artery (ITA) graft is sometimes too short for sequential bypass in cases of distal stenosis of the LAD coronary artery, we used a free, short segment of the pedicled left ITA for coronary-coronary bypass grafting. The in situ remnant of the left pedicled ITA was used to bypass the proximal LAD stenosis. The patient's postoperative course was uneventful. Predischarge angiogram (on the 9th postoperative day) showed an in situ left ITA graft as well as a free coronary-coronary ITA graft. The patient had a regular follow-up after 3 months, and was classified as New York Heart Association (NYHA) class I. Discussion Primarily used in aorto-coronary bypass surgery (termino-terminal interposition of the saphenous vein between two parts of a resected coronary artery), CCBG was revised latter on, and from hemodynamic point of view the physiologic restoration of coronary blood flow has been confirmed. CCBG might be an attractive approach for bypassing distal lesions of large coronary arteries (combined with arterial or venous grafting of targeted arteries, if proximal stenoses are also present). The proximal remnant of ITA can be used as an in situ or free graft.
Transfusion associated graft versus host disease in an immunocompetent individual following coronary artery bypass grafting
Nagendra Girish,Ramakrishna M,Hegde Devi,Damodar Sharad
Indian Journal of Critical Care Medicine , 2008,
Abstract: Transfusion associated graft versus host disease (TA-GVHD) is a rare but commonly fatal complication of transfusion of cellular blood products, which usually occurs in immunosuppressed individuals following transfusion and subsequent engraftment of viable T lymphocytes. Very rarely it may arise in apparently immunocompetent individuals. The clinical syndrome consists of fever, skin rash, diarrhoea, hepatic dysfunction, and bone marrow aplasia. The outcome is nearly always fatal. We present here a case report of fatal TA-GVHD in a "presumed" immunocompetent patient, post coronary artery bypass grafting surgery after transfusion of blood products. The patient died 24 days after transfusion. There is a perceived increased risk of TA-GVHD following bypass grafting and other surgical procedures where cardiopulmonary bypass is required. TA-GVHD is probably underreported and the incidence is felt to be too low to warrant routine irradiation of cellular products for this group of patients. Clinicians, pathologists, and transfusion centers should be aware of this rare but devastating complication of blood transfusion after cardiac surgery.
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