Female ; Humans ; Myocardial Infarction ; surgery ; Myocardial Revascularization

internal thoracic artery is used in myocardial revascularization because of many advantages. However, it may not be appropriate in the usual extrapleural or intrapleural route, because it can be easily displaced and injured due to the slender and weak characteristics. We introduce here, a simple technique of repositioning the skeletonized left internal thoracic artery in a stable and straight course by creating a tunnel between the left lateral pericardium and thymic tissue.
Mammary Arteries* ; Myocardial Revascularization ; Pericardium ; Skeleton*

Cardiac Catheterization ; standards ; Humans ; Myocardial Revascularization ; standards ; Risk Factors

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*

BACKGROUND: Several studies suggested that T-wave normalization (TWN) in exercise ECG indicates the presence of viable myocardium. But the clinical implication of this phenomenon in patients with acute myocardial infarction who received proper revascularization therapy was not determined. Precisely the aim of this study was to investigate the relationship between TWN in exercise ECG and myocardial functional recovery after acute myocardial infarction. METHODS: We studied 30 acute myocardial infarction patients with negative T waves in infarct related electrocardiographic leads and who had received successful revascularization therapy. Exercise ECG was performed 10 ~14days after infarct onset using Naughton protocol. Patients were divided into 2 groups according to presence (group I; n=14) or not (group II; n=16) of TWN in exercise ECG. Exercise parameters and coronary angiographic findings were compared between groups. Baseline and follow-up (mean 11 months) regional and global left ventricular function was analyzed by echocardiography. RESULTS: Exercise parameters were similar between groups. There was no difference in baseline ejection fraction and wall motion score between group I and II (EF; 56 +/- 12% vs 52 +/- 11%, p=ns. WMS; 21 +/- 3 vs 23 +/- 4, p=ns) and it was improved at the tenth month by similar magnitude (group I/group II, EF % change = 12 +/- 12% vs 7 +/- 6%, p=ns, WMS % change=6 +/- 6% vs 7+/- 5%, p=ns). The finding of no relation between TWN and functional recovery was observed also when the patients were analysed according to infarct location and presence or absence of Q-waves. CONCLUSION: As the exercise-induced TWN in patients with acute myocardial infarction was not related with better functional recovery of dysfunctional regional wall motion and ejection fraction, TWN does not appear to be an indicator of myocardial viability.
Aged ; Electrocardiography ; Exercise Test ; Female ; Human ; Male ; Middle Age ; Myocardial Infarction/*physiopathology/surgery ; Myocardial Revascularization

BACKGROUND: Transmyocardial revascularization (TMR) in end stage ischemic heart disease results in variable clinical responses. We investigated the acute effect of early reperfusion and the angiogenesis after formation of the transmyocardial channel in a transplanted rat heart model with acute myocardial infarction. MATERIAL AND METHOD: In the 30 transplanted hearts we induced acute myocardial infarction by ligating the proximal left coronary artery and inserted a porous 22G intravenous cannula into the left ventricle. After ten minutes of reperfusion, we removed the cannula. At every stage, we recorded the heart rate, QRS size, and left coronary arterial blood flow using the electrocardiogram and Doppler. One week later the rats were sacrificed and evaluated for the patency of intramyocardial channels and the angiogenesis. RESULT: The heart rates after ligation and after cannula insertion were 239.1+/-61.7, 235.8+/-58.0 bpm respectively, and they were statistically significantly slower than that of before ligation, 277.6+/-40.3 bpm (p=0.017, p=0.007 respectively). QRS sizes before ligation, after ligation, and after cannula insertion were 3.6+/-3.3 mm, 2.8+/-3.3 mm, and 2.4+/-2.2 mm, respectively, and there was no significant difference in the three groups. Doppler findings after ligation showed that average peak and mean values of coronary perfusion were significantly decreased from 2.11+/-0.17 kHz, 1.25+/-0.22 kHz to 0.83+/-0.15 kHz, 0.38+/-0.11 kHz (p<0.05 respectively). After insertion of the porous cannula, the average peak and mean values of coronary perfusion were 0.61+/-0.05 kHz and 0.33+/-0.05 kHz respectively, but there was no statistically significant change compared to values after ligation. In all cases except one, pathologic findings showed no patent channels in the acute stage, however, one case showed the angiogenesis. CONCLUSION: We confirmed that TMR in a rat heart transplant model did not show blood flow through the channel in the acute stage. However, reperfusion effect in some cases had a potential for angiogenesis.
Animals ; Catheters ; Coronary Vessels ; Electrocardiography ; Heart Rate ; Heart Ventricles ; Heart* ; Ligation ; Myocardial Infarction ; Myocardial Ischemia ; Myocardial Revascularization ; Perfusion* ; Rats* ; Reperfusion

The potential for recovery of left ventricular dysfunction after myocardial revascularization represents a practical clinical definition for myocardial viability. The evaluation of viable myocardium in patients with severe global left ventricular dysfunction due to coronary artery disease and with regional dysfunction after acute myocardial infarction is an important issue whether left ventricular dysfunction may be reversible or irreversible after therapy. If the dysfunction is due to stunning or hibernation, functional improvement is observed. but stunned myocardium may recover of dysfunction with no revascularization. Hibernation is chronic process due to chronic reduction in the resting myocardial blood flow. There are two types of myocardial hibernation: "functional hibernation" with preserved contractile reserve and "structural hibernation" without contractile reserve in segments with preserved glucose metabolism. This review focus on the application of F-18 FDG and other radionuclides to evaluate myocardial viability. In addition the factors influencing predictive value of FDG imaging for evaluating viability and the different criteria for viability are also reviewed.
Coronary Artery Disease ; Glucose ; Hibernation ; Humans ; Metabolism ; Myocardial Infarction ; Myocardial Revascularization ; Myocardial Stunning ; Myocardium ; Radioisotopes ; Ventricular Dysfunction, Left

OBJECTIVETo investigate the application of the retroperitoneal approach in aortic surgery.

METHODSWe collected and analyzed data of 7 patients in Macau who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion.

RESULTSNo operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation.

CONCLUSIONRetroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.

Aged ; Aorta ; surgery ; Humans ; Myocardial Revascularization ; methods ; Peritoneal Cavity ; Treatment Outcome ; Vascular Surgical Procedures ; methods

OBJECTIVETo demonstrate the effect of early strategies and revascularization patterns on in-hospital major adverse cardiac events (MACE) in patients with non-ST-segment elevation acute coronary syndrome (ACS) at intermediate or high risk.

METHODS910 Patients with non-ST-segment elevation ACS at intermediate or high risk were divided into either early invasive (n = 237) or initially conservative (n = 673) group according to whether or when coronary angiography (CAG) was performed after admission ( 48 h) in order to demonstrate the impact of early strategies and revascularization patterns on in-hospital MACE events (death, new-onset myocardial infarction or repeat revascularization).

RESULTSCompared with those of the initially conservative group, patients in the early invasive group had a shorter hospital stay and increased rate of MACE (6.3% vs 2.5%, OR 0.384, 95% CI 0.188 - 0.781, P = 0.006) or new-onset myocardial infarction (4.6% vs 0.9%, OR 0.185, 95% CI 0.068 - 0.505, P = 0.001), which was partly due to increased procedures of revascularization (86.9% vs 67.5%, P < 0.001). No differences were found among in-hospital mortality or rate of repeat revascularization between the two groups. During subgroup analysis, patients receiving PCI in the early invasive or initially conservative group had comparable rates of new-onset myocardial infarction, repeat revascularization or MACE events, whereas patients receiving CABG in the early invasive group had a higher rate of new-onset myocardial infarctions than those in the initially conservative group (7.5% vs 1.8%, P = 0.027).

CONCLUSIONSAn early invasive strategy in patients with non-ST-segment elevation ACS had comparable in-hospital mortality and higher rate of in-hospital myocardial infarction compared with an initially conservative strategy, an early invasive strategy with PCI seems safe and feasible without increased risk of adverse clinical events. The impact of early CABG on in-hospital adverse events warrants further investigation.

Acute Coronary Syndrome ; drug therapy ; physiopathology ; therapy ; Electrocardiography ; Female ; Humans ; Length of Stay ; Male ; Myocardial Revascularization

Coronary artery bypass grafting(CABG) without cardiopulmonary bypass(CPB) is now an accepted technique of myocardial revascularization in selective cases of coronary arterial occlusive disease. The lesion was total(100%) occlusion of proximal right coronary artery (RCA) without any evidence of disease in the rest of coronary arteries. Percutaneous transluminal angioplasty(PTCA) was tried but unsuccessful. We herein report a case of successful CABG to right coronary artery without CPB on a patient with complete occlusion of RCA and symptomatic with minimal activity.
Arterial Occlusive Diseases ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Myocardial Revascularization ; Surgical Procedures, Minimally Invasive