Transmycardial laser revascularization has made its position as a sole therapy for patients with chronic angina nonamenable to maximal medical therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting. We report three cases of transmyocardial laser revascularization as a sole therapy for patients with recurrent angina after CABG.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Humans ; Transmyocardial Laser Revascularization

About 1,000 patients undergo aortic surgery annually in Korea. Unlike Western countries, emergency surgery for dissection or ruptured aneurysm is more frequent than elective cases. Because timely diagnosis and intervention are essential for improving the treatment outcome, medical professionals should be provided with accurate knowledge about the nature of the diseases and currently available treatment modalities along with their results. Aortic dissection is the most frequent among the acute aortic diseases. Although there is a wide variation in surgical results between hospitals, experienced centers are reporting early survival rates higher than 90% after a surgery for acute type A dissection. The majority of the patients with acute type B dissection can be treated medically. For those who have serious complications such as rupture or malperfusion, catheter-based intervention became a promising alternative to surgery. Aortic intramural hematoma and penetrating atherosclerotic ulcer are known to have better prognosis than dissection. However, treatment plans should be decided individually, because many of such lesions can progress into dissection or rupture. Because the result of surgery for ruptured degenerative aneurysm is poor, surveillance and timely intervention is of utmost importance. The mortality rate after elective aortic surgery has come into a satisfactory range; <10% for the thoracic and <5% for the abdominal aorta. Endovascular repair has been established as an effective treatment for the abdominal aortic aneurysm. However, its effectiveness and proper indications for thoracic aortic diseases are not fully determined. Refinement of device and combination with surgical repair (hybrid technique) will widen the indication of stent-grafting.
Aneurysm ; Aneurysm, Ruptured ; Aorta ; Aorta, Abdominal ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Aortic Diseases ; Emergencies ; Hematoma ; Humans ; Korea ; Prognosis ; Rupture ; Survival Rate ; Treatment Outcome ; Ulcer

BACKGROUND: There is a controversy regarding the pathogenesis and management principle of an acute intramural hematoma (IMH) of the aorta. Recent studies have reported intimal defects in many patients diagnosed with IMH, and suggested that intimal defects play important roles in the pathogenesis, progression of the pathology, and prognosis. MATERIAL AND METHOD: This study reviewed the preoperative and postoperative computed tomography (CT) scan images of 36 patients who underwent surgical treatment for Stanford type A acute IMH of the aorta. The surgical findings were also reviewed retrospectively from the medical records. RESULT: In 15 patients (41.7%), the findings suggestive of the intimal defects were found in the preoperative CT. During the operation, 26 patients (72.2%) were found to have small intimal defects in the ascending aorta or the arch, of which 13 patients (50.5%) did not have the CT findings suggestive of intimal defects. In 17 patients, the intimal defects were located in the aortic arch or distal ascending aorta, where a gross examination would have been impossible without total circulatory arrest. In all patients, the intimal defects identified were included in the resected aortic segment, or locally closed. Follow-up CT at 4 months or longer after surgery showed that the IMH in the descending aorta had disappeared or was markedly improved. CONCLUSION: Most patients undergoing surgical treatment for acute type A IMH had intimal defects. This suggests that a large proportion of IMH might have a similar pathogenic mechanism as classic dissection. Consequently, it is believed that those two entities of acute aortic syndrome should be treated using the same principles.
Aorta* ; Aorta, Thoracic ; Follow-Up Studies ; Hematoma* ; Humans ; Medical Records ; Pathology ; Prevalence* ; Prognosis ; Retrospective Studies

BACKGROUND: This study was aimed to assess improvement in myocardial perfusion after TMR by measuring regional myocardial blood flow(RMBF) in porcine model of chronic myocardial ischemia. MATERIAL AND METHOD: Ameroid ring was placed around the proximal left circumflex coronary artery in fourteen pigs. After 4 weeks, the control group(7 pigs) underwent rethoracotomy only, and the TMR group(7 pigs) underwent Ho:YAG laser TMR at the circumflex territory. After another 4 weeks, the animals were sacrificed for the measurement of RMBF using colored microspheres. The ratio of RMBF between the circumflex territory and the interventricular septum was calculated and compared. RESULT: At 4 weeks after ameroid constriction, RMBF of the circumflex territory decreased to 46~89% of RMBF of the interventricular septum. In five of six animals in the TMR group, RMBF of the circumflex territory at 8 weeks after ameroid constriction was higher compared with RMBF at 4 weeks after ameroid constriction. However, the improvement was statistically significant only in two animals. In three of the four animals in the control group, RMBF of the circumflex territory also increased at 8 weeks compared with RMBF at 4 weeks. The degree of increase in RMBF was not different between the control and the TMR groups. CONCLUSION: In porcine model of chronic myocardial ischemia, the degree of increase in RMBF of the ischemic area after Ho:YAG TMR was not different from the increase by development of native collateral circulation. Perfusion of ischemic myocardium after TMR is not thought to improve to the degree that can be demonstrated by currently available method of assessment such as radioisotope myocardial scintigraphy.
Animals ; Collateral Circulation ; Constriction ; Coronary Artery Disease ; Coronary Vessels ; Laser Therapy ; Microspheres ; Myocardial Ischemia* ; Myocardial Perfusion Imaging ; Myocardial Revascularization ; Myocardium ; Perfusion ; Swine ; Transmyocardial Laser Revascularization*

The results of surgical bypass and endarterectomy in Takayasu's arteritis (TA) were reported to be poor compared to usual atherosclerosis patients. However, if ischemic symptoms due to occlusive disease were severe, surgical procedures were inevitable. We report surgical experience of 5 patients with TA. Five women (ranged from 26 to 58 yr) were operated between June 1998 and May 2004. Three patients showed occlusion of main branches of aortic arch and had symptoms of cerebral ischemia. One patient showed near total occlusion in the midabdominal aorta and had symptoms of orthopnea and uncontrolled hypertension. One patient showed total occlusion of abdominal aorta at the level of aortic bifurcation and had a symptom of severe claudication on both legs. Bypasses from the ascending aorta to the carotid artery were performed in 3 cases. Bypass from the thoracic aorta to the left common iliac artery was performed in one case and endarterectomy of abdominal aorta in one case. The ischemic symptoms related with arterial occlusion were resolved after surgery. And the symptoms of cardiac failure disappeared. The symptomatic TA frequently required arterial reconstruction. The symptomatic improvement and excellent mid-term patency could be expected after arterial reconstruction and endarterectomy.
Adult ; Endarterectomy, Carotid/methods ; Female ; Humans ; Middle Aged ; Migraine Disorders/etiology ; Postoperative Complications ; Takayasu's Arteritis/radiography/*surgery ; Treatment Outcome

We evaluated the feasibility and safety of this method by reviewing the early outcome of the patients who underwent coronary artery bypass grafting(CABG) utilizing parallel sequential anastomoses with saphenous vein grafts, comparing with the outcome of the patients revascularized with grafts having only single distal anastomosis. During the one-year period of 1995, a total of 79 patients underwent isolated CABG, among whom 39 patients with sequential vein grafts(sequential group) and 40 patients without sequential grafts(non-sequential group). There was no difference between the two groups in terms of preoperative status, except in the extent of the coronary disease; 87.2% of the sequential group and 45.0% of the non-sequential group had left main and/or triple vessel involvement. 318 distal coronary anastomoses were done; 198 for the sequential group(5.1/patient) and 120 for the non-sequential group(3.0/patient). In the sequential group, the mean durations of cardiopulmonary bypass and aortic clamp per one distal anastomosis were 33.5 and 21.1 minutes, respectively. In the non-sequential group, these were 41.8 and 22.7 minutes. There were two operative deaths, both in the non-sequential group. There was no difference in the incidence of postoperative complications including myocardial infarction. During the follow-up period(2 to 15 months), 8 patients(3 in the sequential and 5 in the non- sequential group) complained of residual or recurrent angina. Comparison of preoperative and postoperative 201Thallium myocardial perfusion scans in 30 patients showed improved or normal perfusion reserve in 83.3% of segments bypassed with sequential grafts and 82.5% of segments bypassed with non-sequential graft(s). These results show that, utilizing parallel sequential anastomoses with saphenous vein grafts, we could achieve satisfactory short-term clinical results in patients with extensive coronary stenoses. So, we conclude that this technique is a safe, technically feasible strategy for CABG, which can achieve the aim of complete myocardial revascularization with a limited length of graft. These results show that, utilizing parallel sequential anastomoses with saphenous vein grafts, we could achieve satisfactory short-term clinical results in patients with extensive coronary stenoses. So, we conclude that this technique is a safe, technically feasible strategy for CABG, which can achieve the aim of complete myocardial revascularization with a limited length of graft.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Disease ; Coronary Stenosis ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Revascularization* ; Perfusion ; Postoperative Complications ; Saphenous Vein ; Transplants ; Veins

BACKGROUND: Prolonged extracorporeal circulation entails tremendous threats of red cell lysis, severe bleeding problems due to platelet injury and activation, and endothelial damages by sequestered leukocytes. In consideration of these problems, a new centrifugal pump was developed and tested clinically to evaluate its effectiveness. METHODS: We compared the effects of a centrifugal pump with those of a roller pump on hematological responses during cardiopulmonary bypass (CPB) in 20 coronary artery bypass surgery patients. The patients were divided into two groups of 10 each. The studied parameters included WBC counts, platelet counts, plasma Hb and D-dimer. Blood samples were taken after sternotomy, at 60 min, 120 min and 180 min after CPB start, and at 2 hr after CPB stop. RESULTS: No differences between the groups were found in bypass time, aortic cross clamp time, extracorporeal circulation flow and hematocrit. The centrifugal pump group demonstrated less platelet depletion (p<0.05), hemolysis (plasma Hb, p<0.05) and fibrinolysis (D-dimer, p<0.05). These differences were CPB time dependent and became statistically significant after 120 min bypass. CONCLUSION: We conclude that roller pump still can be safely used for standard cardiac procedures with bypass time less than 120 minutes and the centrifugal pump has significant potential to be safely applied to CPB for long ypass time in order to avoid postperfusion syndrome.
Blood Platelets ; Cardiopulmonary Bypass* ; Coronary Artery Bypass ; Extracorporeal Circulation ; Fibrinolysis ; Hematocrit ; Hemolysis ; Hemorrhage ; Humans ; Leukocytes ; Plasma ; Platelet Count ; Sternotomy

A 74-year-old woman presented at our hospital with hemoptysis. Three months ago, she had endovascular stent-grafting done by a general surgeon for a saccular thoracic aneurysm that was found accidentally following an episode of fever and chills. Despite a lasting fever after the procedure, she was discharged without further treatment and follow-up. She was subsequently admitted to the hospital for evaluation and several exams were performed. Chest CT scans and an esophagoscopy identified an aorto-esophageal fistula at the level of the aorta that was covered by a previous stent-graft. After extensive administration of antibiotics, surgery was done - esophagectomy, cervical esophago-gastrostomy and replacement of the thoracic aorta. She was later discharged uneventfully.
Aged ; Aneurysm ; Aneurysm, Infected ; Anti-Bacterial Agents ; Aorta ; Aorta, Thoracic ; Chills ; Esophageal Fistula ; Esophagectomy ; Esophagoscopy ; Female ; Fever ; Fistula ; Follow-Up Studies ; Hemoptysis ; Humans ; Thorax

BACKGROUND: Perioperative transfusion of red blood cell (RBC) may cause adverse effects. Bloodless-cardiac surgery has been spotlighted to avoid those problems. Off pump coronary artery bypass (OPCAB) surgery can decrease the transfusion. However, the risk factors of transfusions in OPCAB have not been investigated properly. MATERIALS AND METHODS: One hundred and thirteen patients (male:female=35:78, mean age=66.7+/-9.9 years) who received isolated OPCAB were retrospectively analyzed from March 2006 to September 2007. The threshold of RBC transfusion was 28.0% of hematocrit. Bilateral internal thoracic arteries graft were used for 99 patients (87.6%). One hundred and three (91.1%) and 35 patients (31.5%) took aspirin and clopidogrel just before surgery. RESULTS: Sixty-five patients (47.5%) received the RBC transfusion (mean 2.2+/-3.2 units). Mortality and major complications were not different between transfusion and no-transfusion group. But, ventilator support time, intensive care unit stay and hospitalization period had been reduced in no-transfusion group (p<0.05). In multivariate analysis, patients risk factors for RBC transfusion were preoperative low hematocrit (<37.5%) and clopidogrel medication. Surgical risk factors were longer graft harvesting time (>75 minutes) and total operation time (>5.5 hours, p<0.05). CONCLUSION: We performed the transfusion according to transfusion guideline; over 40% cases could conduct the OPCAB without transfusion. There were no differences in major clinical results between transfusion and non-transfusion group. In addition, when used together with accurate understanding of transfusion risk factors, it is expected to increase the proportion of patients that do not undergo transfusions.
Aspirin ; Blood Transfusion ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Erythrocyte Transfusion ; Erythrocytes ; Hematocrit ; Hospitalization ; Humans ; Intensive Care Units ; Mammary Arteries ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Ticlopidine ; Transplants ; Ventilators, Mechanical

Ascending aortic aneurysms are usually treated with graft replacement under cardiopulmonary bypass. However, if a candidate for off-pump coronary artery bypass grafting has an enlarged ascending aorta, surgeons may consider wrapping it without cardiopulmonary bypass. Here, we report a 78-year-old female who underwent successful wrapping of the ascending aorta concomitant with off-pump coronary artery bypass grafting, using a new wrapping technique that involves multiple bootstraps.
Aged ; Aorta ; Aortic Aneurysm* ; Aortic Aneurysm, Thoracic ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Female ; Humans ; Transplants*