• Journal of Chest Surgery
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• 제48권4호
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• pp.285-288
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• 2015

In coronary artery bypass grafting, a diffusely diseased left anterior descending coronary artery (LAD) is an obstacle to achieving complete revascularization, consequently leading to the possibility of a poor prognosis. Long segmental reconstruction with or without endarterectomy is a revascularization method for treating diffusely diseased coronary arteries. Herein, we report a successful case of long segmental reconstruction of a diffusely diseased LAD using a left internal thoracic artery onlay patch after endarterectomy.

• Journal of Chest Surgery
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• 제52권2호
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• pp.109-111
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• 2019

We report the case of a female patient who underwent late reoperation following endocarditis surgery. The patient first underwent surgery at 22 years of age for endocarditis with aortic and tricuspid insufficiency. She underwent aortic root replacement with a homograft and tricuspid valve replacement with a tissue valve. Coronary artery bypass using the internal thoracic artery and ligation of the left main coronary artery were performed. Ten years later, failure of the homograft and the tricuspid valve developed. In the second operation, the patient underwent a successful Bentall operation and tricuspid valve replacement with a mechanical valve under deep hypothermia and retrograde cold cardioplegia without drainage.

• Journal of Chest Surgery
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• 제39권9호
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• pp.710-713
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• 2006

관상동맥우회술을 시행 받은 환자가 많아지면서 관상동맥 재수술의 빈도도 증가하고 있다. 또한 기술적인 발전으로 인하여 심폐바이패스 없이 시행하는 관상동맥우회술도 늘고 있다. 저자들은 관상동맥 우회술 후 재발된 76세 불안정성 협심증 환자에게 좌측 개흉술 및 상복부 절개술을 통한 관상동맥재수술을 시행하여 만족스러운 결과를 얻었기에 이를 보고하고자 한다.

• Journal of Chest Surgery
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• 제50권6호
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• pp.460-462
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• 2017

We herein present the unique case of a 68-year-old male diabetic patient who developed sterile necrosis of the sternum 1 month after myocardial revascularization with the use of bilateral internal thoracic artery grafts. The sternum had been closed by the bilateral Robicsek wiring technique. The sternum was removed, and bilateral pectoralis major flaps were used to cover the defect. The patient had an uneventful recovery.

• Journal of Chest Surgery
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• 제44권1호
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• pp.64-67
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• 2011

Constrictive pericarditis is a rare complication after coronary artery bypass grafting In most cases pericardiectomy is required as a definitive treatment. However, there are several types of constrictive pericarditis such as transient cardiac constriction. Some types of constrictive pericarditis can only be managed with medical therapy. We report a 72-year-old female patient who developed subacute transient constrictive pericarditis with persistent left pleural effusion as a result of postcardiac injury syndrome. The patient went through coronary bypass surgery that was successfully treated with postoperative steroid therapy.

• BMB Reports
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• 제39권4호
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• pp.377-382
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• 2006

Oxidative stress occurs in patients undergoing coronary artery bypass operation. The aim of this study was to investigate the difference in oxidative stress in off-pump versus on-pump coronary artery bypass surgery. In the present study, in serial blood samples, plasma malondialdehyde (MDA) as index of lipid peroxidation, red blood cells glutathione peroxidase (GPx) and superoxide dismutase (SOD) were measured to compare the extent of oxidative stress in 30 patients undergoing OPCAB (off-pump coronary artery bypass grafting), 12 patients undergoing CABG (on-pump coronary artery bypass grafting) and 18 healthy controls. In CABG group, MDA levels increased significantly from $2.87{\pm}0.62\;nmol/mL$ before anesthesia and $2.87{\pm}0.65\;nmol/mL$ after anesthesia to $3.05{\pm}0.66\;nmol/mL$ after ischemia (p < 0.05). Similarly, SOD levels also elevated significantly from $661.58{\pm}78.70\;U/g$ Hb before anesthesia and $659.42{\pm}81.21\;U/g$ Hb anesthesia induction to $678.08{\pm}75.80\;U/g$ Hb after ischemia (p < 0.01, p < 0.01, respectively). In OPCAB group, only SOD levels increased from $581.73{\pm}86.24\;U/g$ Hb anesthesia induction to $590.90{\pm}88.90\;U/g$ Hb after reperfusion (p < 0.05). Glutathione peroxidase levels were not changed according to blood collection times in both of CABG group or OPCAB group (p > 0.05). Our results show that only mild signs of oxidative stress is found after reperfusion in OPCAB operation compared with CABG operation. Further studies are needed in order to confirm this hypothesis.

• Journal of Chest Surgery
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• 제22권4호
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• pp.661-666
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• 1989

Congenital coronary arterial fistulae are the most prevalent hemodynamically significant congenital coronary artery malformations. Definition of congenital coronary arterial fistula is a direct communication between a coronary artery and the lumen of one of the four cardiac chambers or coronary sinus or SVC, pulmonary artery or pulmonary vein close to the heart. It is often associated with additional congenital or acquired heart disease. A 49 year old male patient was admitted with the chief complaints of anginal pain and exertional dyspnea for 9 months. He was diagnosed as the right coronary arterial fistula combined with right coronary arteriosclerotic stenosis and old inferior myocardial infarction by cardiac evaluation. The right coronary arterial fistula was communicated between the just distal portion of acute marginal branch and coronary sinus. The operative procedure was as followings; after suture ligation of fistula opening in the coronary sinus under beating heart, coronary arterial bypass grafting with saphenous vein was performed at the just proximal portion of the posterior descending branch under cardiopulmonary bypass. The postoperative course was uneventful and he was discharged without anginal pain at the 8th postoperative day.

• Journal of Chest Surgery
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• 제22권6호
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• pp.1092-1100
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• 1989

Since May 1987 to April 1989, fifteen patients have been subjected to coronary artery bypass graft [CABG] including coronary thromboendarterectomy in 3 patients at Hanyang University Hospital. The correlation between the preoperative coronary angiography, electrocardiography, clinical status, operative finding and postoperative blood flow, complication and degree of clinical improvement were evaluated. 1. Ten patients [67 %] were male and five patients [33 %] were female, Ages ranged from 30 to 68 years. [average 52.2 years] 2. The angina by types of presentation was stable in 3 patients, unstable in 12 patients with resting, postinfarction and progressive angina as the criteria of unstability. 3. The number of involved vessels were single in 6 cases, double in 4 cases, triple in 5 cases including 1 case of left main coronary arterial disease. 4. The distribution of sites of distal anastomosis revealed predilection to left coronary arterial system [83 %], especially left anterior descending arterial system. 5. The author performed 4 cases of single bypass, 4 cases of double bypass, 5 cases of triple bypass and 2 cases of quadruple bypass. Of these 15 patients, 3 patients received coronary thromboendarterectomy, LAD in 2 patients and right coronary artery [RCA] in 1 patient. 6. The distal anastomosis were performed first with using saphenous vein grafts as conduits in all cases except 1 case using Gore-Tex conduit because of deficient in length and narrowed internal mammary artery and sequential bypass methods were employed in last 6 cases. 7. One operative death occurred and therefore, mortality rate was 6.7%. The perioperative myocardial infarction were occurred in 3 cases [20%] and its cause was supposed that they were triple vessel disease and therefore, aortic cross clamping times were relatively long. 8. All survivors were followed for 17.7 months on an average [range 5-28 months] and they have had symptomatic improvement except 1 case having mild degree of angina at 1.5 months after operation.

• Journal of Chest Surgery
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• 제52권3호
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• pp.155-161
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• 2019

Background: Coronary artery bypass grafting (CABG) is being offered increasingly frequently to octogenarians. However, old age is known to be an independent risk factor in CABG. The aim of this study was to compare the outcomes of off-pump coronary artery bypass (OPCAB) between octogenarians and septuagenarians. Methods: We retrospectively reviewed the data of 1,289 consecutive patients aged ${\geq}70years$ who underwent OPCAB at a single institution between 2001 and 2016. We compared the outcomes of 115 octogenarians and 1,174 septuagenarians. Using propensity score matching, based on preoperative clinical characteristics, 114 octogenarians were matched with 338 septuagenarians. Results: Propensity score analysis revealed that the incidence of acute kidney injury (14.9% vs. 7.9%, p=0.028) and respiratory complications (8.8% vs. 4.2%, p=0.040) was significantly higher in octogenarians. The early mortality rate (2.6% vs. 1.0%, p=0.240) and 1-year survival rate (89.5% vs. 94.4%, p=0.097) were not statistically significant between the groups. However, the 5-year survival rate (67.3% vs. 79.9%, p<0.001) was significantly lower in octogenarians. Previous myocardial infarction and a left ventricular ejection fraction ${\leq}35%$ were associated with a poor 1-year survival rate. Conclusion: Early and 1-year outcomes of OPCAB in octogenarians were tolerable when compared with those in septuagenarians. OPCAB could be a suitable option for octogenarians.

• Journal of Chest Surgery
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• 제40권9호
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• pp.633-636
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• 2007

관상동맥 우회술 직후에 발생하는 자가혈관의 연축은 흔하게 발생하지는 않지만, 갑작스럽게 발생하는 심한 저혈압 상태나 심실성 부정맥의 원인이 될 수 있다. 수술 전 관상동맥 조영술에서 의미있는 협착이 없어 우회술을 시행하지 않았던 우 관상동맥의 연축 현상에 의한 저심박출의 발생에 관한 증례를 보고하고자 한다.