Objective To evaluate the minimally invasive surgery in coronary artery bypass grafting and the feasibility for revascularization of triple vessel coronary artery disease.Methods Nine female patients, aged 49.1 to 81.6 years (mean 64.3), were operated on for triple vessel disease through minimally invasive surgical techniques. The surgeries were performed through limited left parasternal incision under femorofemoral extracorporeal circulation. The myocardium was protected by antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped. Under direct vision, the left saphenous vein grafts were connected sequentially to the diagonal branch, obtuse marginal branch and posterior descending branch, and the left internal thoracic arterial graft was anastomosed to the left anterior descending artery in each patient. Results The number of distal anastomoses was 3 to 4 with a mean of 3.7. The aortic crossclamp time was 52 to 130 minutes (82±25 minutes). The duration of extracorporeal circulation was 78 to 151 minutes (115±29 minutes). The postoperative course was uneventful in all patients. The postoperative length of stay was 4 to 12 days (7.2±2.0 days). Follow-up (4.2 to 8.7 months, mean 6.4) was complete in all patients and there were no late deaths or angina. Coronary angiography of 2 patients showed patent grafts. All patients were satisfied with the good cosmetic healing of the incision.Conclusion Our experience demonstrates that minimally invasive surgery in coronary artery bypass grafting is technically feasible and may be an alternative approach in surgical revascularization of triple vessel coronary artery disease, especially in female patients.

Objective To summarize the experience of utilization of video-assisted endoscopy in 91 patients operated on at Chang Gung Memorial Hospital, Taipei, China.Methods From October 1995, through August 1996, 91 patients (44 male and 47 female) received video-assisted cardiac surgery (VACS). Their ages ranged from 1 year to 79.5 years (25.7±21.7). Indications for surgery were atrial septal defect (59 patients), ventricular septal defect (15), coronary artery disease (4), severe mitral regurgitation (4), severe tricuspid regurgitation (3), thrombosis of mitral mechanical prosthesis (3), left atrial tumor (2), and left ventricular thrombus with dilated cardiomyopathy (1). The VACS was performed through right or left anterior minithoracotomy and guided by video-assisted endoscopic techniques by means of projected images on the video monitor under extracorporeal circulation. The aorta was not cross-clamped and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest (rectal temperature 22.6±4.0℃). Conventional instruments were used.Results All lesions were corrected successfully. The bypass time was 27 to 335 minutes (72.8±52.7). The operative time was 1.3 to 8.5 hours (3.0±1.7). There were no operative deaths and 3 late deaths. Follow-up was complete in all survivors (6 to 16 months, mean 8.7). Most of them were found to be in NYHA functional Ⅰ or Ⅱ.Conclusion Our preliminary experiences demonstrate that VACS is simple and effective in surgical correction of selected cardiac lesions. Short-term results show good outcomes.

Neurofibromatosis type 1 (NF-1) is known to develop vascular lesions, yet they are uncommon. If missed or ignored, it can be limb-threatening. When a ruptured pseudoaneurysm is clinically identified, rapid surgical intervention is required. We discuss a case of NF-1 that involved a spontaneous rupture of the right deep brachial artery. A 41-year-old woman reported sudden right arm swelling and intensifying pain. She was hemodynamically stable; however, her right arm was enlarged and tense on examination. A radiological test revealed a deep brachial artery haemorrhage. The patient was promptly referred to a vascular surgeon and had endovascular intervention performed. Early detection, emergency angiography, and endovascular treatment for vascular lesions should be initiated immediately.
Neurofibromatoses