• Journal of Chest Surgery
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• v.20 no.2
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• pp.342-347
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• 1987

Complete occlusion of the main LCA is associated with a poor prognosis if the RCA becomes severely occluded. The functional role of collateral circulation is critical in this situation. This study lends support to the hypothesis that coronary collateral circulation can provide critically needed myocardial blood flow via right to left collaterals. Not surprisingly, left ventricular function was maintained in 4 of the 5 patients studied who had main LCA occlusion and well-developed collateral circulation.

• Clinical and Experimental Pediatrics
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• v.46 no.3
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• pp.302-307
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• 2003

The long-term clinical issues in Kawasaki disease are concerned with the coronary artery lesions that result in aneurysmal formation, thrombotic occlusion, progression to ischemic heart disease, and premature atherosclerosis. We here report a 3 month old infant with Kawasaki disease complicated by giant coronary aneurysm with thrombosis. After urokinase(10,000 IU/kg) and heparin(400 IU/kg) were injected for two days as thrombolytic agents, thrombi were successfully dissolved. Even though long-term oral anticoagulation with low-dose aspirin, dipyridamole and coumadin were administered, thrombosis of the left main coronary artery was slowly increased. five years later, coronary angiography showed nearly total occlusion of the left anterior descending artery and collaterals from the right posterior branch and radionuclide scan demonstrated complete reversible perfusion defect of several portions of the left ventricle.

• Journal of Chest Surgery
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• v.46 no.1
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• pp.84-87
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• 2013

A 60-year-old man visited the outpatient clinic due to one month of recurrent exertional chest pain. Eleven years earlier he had undergone off-pump coronary artery bypass grafting using bilateral internal thoracic artery (ITA) Y-composite grafts based on the left ITA. Preoperative coronary angiography showed patent distal graft anastomoses and visualized the left ITA retrogradely. The arch aortography revealed near-total occlusion of the left subclavian artery at the level of the ostium. The patient underwent left carotid-to-subclavian artery bypass grafting using a 6 mm vascular conduit. Postoperative computed tomographic angiography revealed a patent bypass conduit between the left common carotid artery and left subclavian artery. The patient was discharged on postoperative day 4 with no symptoms or signs of myocardial ischemia.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.228-231
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• 2007

Chest trauma can lead to various cardiac complications ranging from arrythmia to myocardial rupture. Coronary artery injury in patients with blunt chest trauma is rare, and traumatic aneurysm of the left coronary artery is even more unusual than right coronary artery. Injury to the coronary arteries, including intimal aneurysm, dissection, laceration, arteriovenous fistula and thrombosis, are sequelae that rarely occur after a blunt trauma. Occlusion of the coronary artery results is a serious complication for the patient via acute myocardial infarction, We report here on a case of acute myocardial infarction with coronary artery aneurysm that arose from blunt chest trauma in a 33-year-old male, and he was successfully managed by a coronary bypass graft without performing cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.359-361
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• 2023

Coronary ostium obstruction due to dislodgement of the prosthetic valve is a rare and life-threatening complication, and particular caution is required for sutureless aortic valve replacement (AVR) with concomitant valvular surgery. In general, coronary artery bypass surgery is performed when coronary ostium obstruction occurs after AVR, but other options may need to be considered in some cases. Herein, we present a case of coronary artery occlusion in an 82-year-old female patient who had undergone AVR and mitral valve replacement for aortic valve stenosis and mitral valve stenosis at the age of 77 years. A hybrid procedure involving redo AVR and percutaneous coronary intervention after left main coronary ostium endarterectomy was performed. To summarize, we present a case of hybrid AVR in a patient with coronary artery obstruction after AVR that was successfully managed using this method.

• Biomedical Science Letters
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• v.21 no.4
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• pp.198-207
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• 2015

ST-segment elevation myocardial infarction (STEMI) and chronic total occlusion (CTO) of coronary artery are well-known atherosclerotic vascular diseases. However, the difference of intima-media thickness and plaque characteristics of carotid arteries between STEMI and CTO patients were not directly compared in previous studies. Medical records of a total of 158 (101 STEMI, 57 CTO) patients, who underwent carotid artery ultrasonography, were selected for the analysis. The baseline characteristics, ultrasonography findings, and clinical outcomes of the two groups were compared. The prevalence of hypertension, diabetes mellitus, and dyslipidemia was significantly higher in CTO patients. Carotid intima-media thickness ($0.97{\pm}0.13$ vs. $0.78{\pm}0.17cm$, P < 0.0001) and number of plaques ($2.2{\pm}1.0$ vs. $1.7{\pm}1.2$, P < 0.0001) were greater in CTO than STEMI patients. Multiple (${\geq}3$) or echogenic plaques were more frequently observed in CTO patients. During the median follow-up duration of 27 months, major adverse cardiovascular events occurred in 31% of CTO and 14% of STEMI patients (P = 0.008). We found that, compared with STEMI, CTO patients have higher burden of carotid artery atherosclerosis associated with more comorbid diseases and poor clinical outcomes.

• Journal of Chest Surgery
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• v.50 no.2
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• pp.114-118
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• 2017

Kimura disease (KD) is an immune-mediated chronic inflammatory disease of unknown etiology. KD has many complications associated with hypereosinophilia, including various forms of allergic reactions and eosinophilic lung disease. Additionally, hypereosinophilia is associated with hypercoagulability, which may lead to thromboembolic events. A 36-year-old man with KD presented with acute limb ischemia and coronary artery occlusion. He underwent thrombectomy, partial endarterectomy of both popliteal arteries, and coronary artery stent insertion. KD is a systemic disease that affects many organs and presents with thromboembolism and vasculitis. In a patient with KD, physicians should evaluate the vascular system, including the coronary arteries.

• Journal of Mechanical Science and Technology
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• v.19 no.5
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• pp.1158-1168
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• 2005

A shunt from the left ventricle to the left anterior descending artery is being developed for coronary artery occlusive disease, in which the shunt or conduit connects the the left ventricle (LV) with the diseased artery directly at a point distal to the obstruction. To aid in assessing and optimizing its benefit, a computational model of the cardiovascular system was developed and used to explore various design conditions. Computational fluid dynamic analysis for the shunt hemodynamics was also done using a commercial finite element package. Simulation results indicate that in complete left anterior descending artery (LAD) occlusion, flow can be returned to approximately 65% of normal, if the conduit resistance is equal for forward and reverse flow. The net coronary flow can increase to 80% when the backflow resistance is infinite. The increases in flow rate produced by asymmetric flow resistance are enhanced considerably for a partial LAD obstruction, since the primary effect of resistance asymmetry is to prevent leakage back into the ventricle during diastole. Increased arterial compliance has little effect on net flow with a symmetric shunt, but considerably augments it when the resistance is asymmetric. The computational results suggest that an LV-LAD conduit will be beneficial when the resistance due to artery stenosis exceeds 27 PRU, if the resistance is symmetric. Fluid dynamic simulations for the shunt flow show that a recirculating region generated near the junction of the coronary artery with the bypass shunt. The secondary flow is induced at the cutting plane perpendicular to the axis direction and it is in the attenuated of coronary artery.

• Korean Journal of Clinical Pharmacy
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• v.6 no.2
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• pp.32-40
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• 1996

The electrophysiological effects of benzopyran potassium channel openers (PCOs: lemakalim, KR-30450 and KR-30818) on the ischemia/reperfusion-induced arrythmias were investigated. In anesthetized rats, subjected to 45 min occlusion of the left anterior descending coronary artery (LAD) followed by 90 min reperfusion, ventricular arrythmias were identified according to the Lambeth Conventions by lead II ECG. Rats were intravenously given vehicle ($1\%$ DMSO), lemakalim, KR-30450, and KR-30818 alone or in combination with a selective $K_{ATP}$ blocker glibenclamide, 30 min prior to coronary occlusion. Compared to vehicle, lemakalim ($30{\mu}g/kg$ i.v.), the active enantiomer of cromakalim, had a tendancy to increase the duration of ventricular tachycardia (Vl) and ventricular fibrillation (VF), the number of premature ventricular complexes (PVC) and the incidence of VF, especially in the early post-occlusion peroid ($0\~15$ min), while increasing ST-segment elevation. Both KR-30450 ($30{\mu}g/kg$, i.v.) and KR-30818 (30, $100{\mu}g/kg$, i.v.) showed similar proarrhythmic effects to lemakalim (PVC, duration of VT, and incidence of VF) with a tendancy to decrease the duration of VF and ST-segment elevation. Unlike other PCOs, however, glibenclamide (0.3, 1.0 mg/kg) had opposite effects on the induction of arrhythmias (PVC, the duration of VF); it had a tendancy to increase the duration of VT with a slight elevation of ST-segment. It seems likely that glibenclamide (0.3 mg/kg, i.v.), reduced the effects of lemakalim or KR-30450 ($30{\mu}g/kg$, i.v.) on arrhythmias (PVC, VT, VF and ST-segment). These results indicate that, in the coronary occluded rat model of ischemia, lemikuiln and KR-30450 exert a proarrhythmic activity, the effect being considered related to the opening of KATP channel.

• YAKHAK HOEJI
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• v.41 no.1
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• pp.117-125
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• 1997

The pharmacological effects of benzopyran potassium channel openers (lemakalim, KR-30450 and KR-30818) on the occlusion/reperfusion-induced myocardial infarction were investigat ed. In anesthetized rats, subjected to 45-min occlusion of the left anterior descending coronary artery (LAD) followed by 90-min reperfusion, the infarct size was measured by calculating the ratio of infarct zone to area at risk (IZ/AAR) with the Evans blue/TTC technique. Rats were intravenously given vehicle (1% DMSO), lemakalim, KR-30450, and KR-30818 alone or in combination with a selective K$_{ATP}$ blacker glibenclamide, 30 min prior to coronary occlusion. Compared to vehicle, lemakalim (30 ${\mu}$g/kg i.v.), the active enantiomer of cromakalim, had a tendancy to decrease infarct size. KR-30450(30 ${\mu}$g/kg, i.v.). the newly synthetized potassium channel openers (PCOs), caused a reduction of infarct size (from 70${\pm}$4%to 57${\pm}$5%). but KR-30818 (30 ${\mu}$g/kg, i.v.), a metabolite of KR-30450. did not modify infarct size. It seem ed likely that glibenclamide (0.3mg/kg, i.v.), given in combination, reduced the effects of these PCOs, especially KR-30450 (30 ${\mu}$g/kg, i.v.) on the infarct size. These results indicate that. in the coronary occluded rat model of ischemia, lemakalim and KR-30450 may exert cardioprotective activity through a reduction of infarct size, the effect being considered related to the opening of K$_{ATP}$ channel.