Adult ; Coronary Vessel Anomalies ; surgery ; Coronary Vessels ; surgery ; Humans ; Male ; Myocardial Infarction ; surgery ; Percutaneous Coronary Intervention

Angioplasty, Balloon, Coronary ; methods ; Coronary Artery Bypass ; methods ; Coronary Vessels ; surgery ; Humans

Aged ; Arterio-Arterial Fistula ; pathology ; surgery ; Coronary Vessel Anomalies ; pathology ; surgery ; Coronary Vessels ; pathology ; surgery ; Humans ; Male

Recently, Minimally invasive direct coronary artery bypass(MIDCAB) procedure eliminating cardiopulmonary bypass becomes one of the rapidly developing strategies in cardiac surgery. Here, we report a case of minimally invasive axillocoronary bypass as coronary reoperative procedure in which the previous LAD graft was occluded and the left internal mammary flow was deemed inadequate. The methodology is described with review of the relevant literature.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels ; Reoperation* ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery ; Transplants

An intrathoracic mass that manifested compression sign of large vessel and heart by mass was confirmed as huge sinoatrial nodal artery aneurysm and resection of aneurysm was performed. Preoperative precise diagnosis of coronary artery aneurysm is difficult because the most coronary artery aneurysm is incidentally confirmed during diagnostic coronary angiography or autopsy. So huge coronary artery aneurysm which manifests compression sign of large vessel and heart by the mass may be misdiagnosed as simple mediastinal mass. We reports huge coronary artery aneurysm that manifested compression sign of large vessel and heart by the mass with reviews of anesthetic management and diagnostic approach.
Aneurysm* ; Arteries* ; Autopsy ; Coronary Angiography ; Coronary Vessels ; Diagnosis ; Heart* ; Humans ; Thoracic Surgery*

BACKGROUND: Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. Several therapeutic and preventive strategies have been introduced for postoperative AF, but the treatment and prophylaxis of AF remain controversial. We aimed to compare the efficacy of intravenous amiodarone and oral propafenone in the treatment of AF after coronary artery bypass grafting (CABG). METHODS: This was a randomized controlled trial performed in two hospitals in Shiraz, Iran from 2009 to 2012. We included all patients who underwent elective CABG and developed AF postoperatively. The patients were randomly assigned to receive propafenone or amiodarone. The duration of AF, the success rate of the treatment, the need for cardioversion, the frequency of repeated AF, and the need for repeating the treatment were compared. RESULTS: The duration of the first (p=0.361), second (p=0.832), and third (p=0.298) episodes of AF, the need for cardioversion (p=0.998), and the need to repeat the first and second doses of drugs (p=0.557, 0.699) were comparable between the study groups. Repeated AF was observed in 17 patients (30.9%) in the propafenone group and 23 patients (34.3%) in the amiodarone group (p=0.704). CONCLUSION: Oral propafenone and intravenous amiodarone are equally effective in the treatment and conversion of recent-onset AF after CABG.
Amiodarone* ; Atrial Fibrillation* ; Coronary Artery Bypass* ; Coronary Vessels* ; Electric Countershock ; Humans ; Iran ; Propafenone* ; Thoracic Surgery

BACKGROUNDMajor side branch (SB) occlusion is one of the most serious complications during percutaneous coronary intervention (PCI) for bifurcation lesions. We aimed to characterize the incidence and predictors of major SB occlusion during coronary bifurcation intervention.

METHODSWe selected consecutive patients undergoing PCI (using one stent or provisional two stent strategy) for bifurcation lesions with major SB. All clinical characteristics, coronary angiography findings, PCI procedural factors and quantitative coronary angiographic analysis data were collected. Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion. SB occlusion after main vessel (MV) stenting was defined as no blood flow or any thrombolysis in myocardial infarction (TIMI) flow grade decrease in SB after MV stenting.

RESULTSAmong all 652 bifurcation lesions, 32 (4.91%) SBs occluded. No blood flow occurred in 18 lesions and TIMI flow grade decreasing occurred in 14 lesions. In multivariate analysis, diameter ratio between MV/SB (odds ratio [OR]: 7.71, 95% confidence interval [CI]: 1.53-38.85, P = 0.01), bifurcation angle (OR: 1.03, 95% CI: 1.02-1.05, P < 0.01), diameter stenosis of SB before MV stenting (OR: 1.05, 95% CI: 1.03-1.07, P < 0.01), TIMI flow grade of SB before MV stenting (OR: 3.59, 95% CI: 1.48-8.72, P < 0.01) and left ventricular eject fraction (LVEF) (OR: 1.06, 95% CI: 1.02-1.11, P < 0.01) were independent predictors of SB occlusion.

CONCLUSIONSAmong clinical and angiographic findings, diameter ratio between MV/SB, bifurcation angle, diameter stenosis of SB before MV stenting, TIMI flow grade of SB before MV stenting and LVEF were predictive of major SB occlusion after MV stenting.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Angiography ; Coronary Stenosis ; diagnostic imaging ; surgery ; Coronary Vessels ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; methods ; Treatment Outcome

OBJECTIVETo assess long-term outcome of coronary artery diseased patients undergone the surgical angioplasty of left main coronary artery.

METHODSFrom September 1983 to December 2004, 162 patients were operated on for left main coronary artery stenosis with surgical angioplasty. The data were retrospectively analyzed. Operative death associated factors were evaluated with univariate analysis, and long-term survival was estimated by Kaplan-Meier analysis.

RESULTSThe in-hospital mortality was 8% for all the patients but only 5.1% for the patients with simple left main coronary artery stenosis. A significant drop of operative mortality was noted in the later era of treatment (1983 to 1994 vs. 1994 to 2004). The operative death was more likely associated with no-isolated left main coronary artery pathologic feature and the urgency of surgery. An average of 102 (8 to 264) months' follow-up was completed in 95% of discharged patients. Coronary event occurred in 42 patients in the follow-up period and it was mortal for 9 cases. The overall long-term survival was 81% at 10 years and 52% at 20 years. The coronary event-free survival was 77% at 10 years and 41% at 20 years.

CONCLUSIONSSurgical angioplasty of left main coronary artery could produce excellent long-term outcome with acceptable per-operative mortality in left main coronary artery stenosis patients. This technique should deserve an important place in therapeutic options for this cohort of patients.

Angioplasty ; methods ; Coronary Stenosis ; surgery ; Coronary Vessels ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate effectiveness of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery.

METHODSBetween April 1999 and August 2005, 12 patients with anomalous origin of the coronary artery from the pulmonary artery underwent surgical correction. There were 8 patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), and 4 patients with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). Eight patients underwent direct aortic reimplantation, and 4 patients underwent a Takeuchi procedure (intrapulmonary artery baffle with an autologous pericardial patch). Simultaneous mitral annuloplasty was performed in 7 patients of ALCAPA with moderate and severe mitral regurgitation. One patient of ARCAPA was associated with an atrial septal defect (ASD) which was closed with an amplatzer septal occluder through right atrium under transesophageal echocardiography (TEE) without CPB.

RESULTSThere were neither early and late deaths nor postoperative complications. Follow-up of all patients ranged from 7 to 83 months (mean, 32 +/- 24 months). The left ventricular function after operation improved from a preoperative fractional shortening (FS) of 0.21 +/- 0.09 to 0.35 +/- 0.06 (P = 0.006) for patients with ALCAPA. Preoperative mitral regurgitation decreased in 7 patients of ALCAPA after mitral annuloplasty at the follow-up. All patients were doing well and their exercise tolerance improved to normal. They were free from symptoms.

CONCLUSIONSReestablishment of a two-coronary system is necessary for patients with anomalous origin of the coronary artery from the pulmonary artery. The left ventricular function improved after 2-coronary repair. We recommend that the simultaneous mitral annuloplasty should be performed at the time of operation for patients who have moderate and severe mitral regurgitation with ALCAPA. Surgical correction of ARCAPA and ARCAPA show good early and mid-term results, long-term results need to be followed up.

Adolescent ; Adult ; Aorta ; surgery ; Child ; Child, Preschool ; Coronary Vessel Anomalies ; surgery ; Coronary Vessels ; surgery ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Pulmonary Artery ; abnormalities ; surgery ; Treatment Outcome

BACKGROUND AND OBJECTIVES: The recently discovered myokine irisin has a proposed role in adipose tissue metabolism. The aim of this study was to evaluate the relationship between serum irisin level and the coronary artery severity in patients with stable coronary artery disease (CAD). SUBJECTS AND METHODS: Sixty-three patients who underwent coronary angiography (CA) diagnosed with stable CAD and twenty-six patients with normal coronary artery (NCA) were enrolled in the study. Stable CAD patients were divided into two groups as high synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score (≥23) and lower SYNTAX score (<23). Serum irisin level measurement was carried out using human irisin colorimetric enzyme-linked immunosorbent assay (ELISA) commercial kit (AG-45A-0046EK-KI01, Adipogen, San Diego, CA, USA) as recommended by the manufacturer's protocol. RESULTS: The patients with stable CAD with a higher SYNTAX score (score ≥23) had significantly lower serum irisin levels (127.91±55.38 ng/mL), as compared the patients with a low SYNTAX score (score <23) (224.69±92.99 ng/mL) and control group (299.54±123.20 ng/mL). Irisin levels showed significant differences between all groups (p<0.001). CONCLUSION: Serum irisin level is an independent predictor of coronary artery severity in patients with stable CAD.
Adipose Tissue ; Angina, Stable* ; Atherosclerosis ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Metabolism ; Percutaneous Coronary Intervention ; Taxus ; Thoracic Surgery