Evaluation of 56 cases of long-segment anastomosis of LITA to LAD in Rajaei heart center

Long-segment reconstruction of the diffusely diseased left anterior descending artery [LAD] with left internal thoracic artery [LITA] is one of the methods offered in order to deal with complicated, multiple, and long-segment lesions in the LAD. In this prospective study, we analyzed the results obtained with this technique. Between Feb. 2007 and Feb. 2009, 56 patients underwent surgery via this technique. The LITA was used as a patch along the opened narrow segment of the LAD from 2 to 8 cm. Data on all the patients were collected, and all the patients were worked up for postoperative complications such as postoperative myocardial infarction, ECG changes, NIHA class, enzymatic changes, and postoperative bleeding. CT-Angiography was performed between 6 to 1 8 months after surgery in some cases. Fifty-six cases, comprising 42 [75%] men and 14 [25%] women between 43 and 78 years of age [mean age= 59.8 +/- 9.3 years] with multiple and long-segment lesions in the LAD were included in this study. Preoperative risk factors were hypertension [66.1%], diabetes [57.1%], hyperlipidemia [50%], cigarette smoking [50%], renal failure [1.8%], and positive family history [7.1%]. Twenty-three [41.1%] patients had remote and 9 [16.1%] had recent myocardial infarction. Significant left main lesions were found in 7 [12.5%] patients, peripheral vascular disease in 3 [5.3%], and preoperative arrhythmias in 2 [3.6%]. The mean number of grafts was 2.85 +/- 1.5. Postoperative complications were arrhythmias in 10 [1 7.8%] patients, postoperative myocardial infarction in 1 [1.8%], surgical bleeding in 7 [12.5%], infections in 3 [5.3%], plural effusion in 3 [5.3%], tamponade in 2 [3.6%], and pericardial effusion in 1 [1.8%]; there was no mortality amongst the patients. CT-angiography, performed in 6 patients between the six and eighteenth postoperative months, revealed patent anastomoses in all the patients. Long segment and multiple lesions in the LAD pose a challenge for cardiac surgeons. The results of long-segment LAD reconstruction using the LITA are very encouraging

Coronary artery revascularization in a young adult with solitary coronary aneurysm probably secondary to childhood Kawasaki disease

Surgical revascularization for coronary artery lesions secondary to Kawasaki disease [KD] has been rarely reported in adolescent patients. We report a young adult with no coronary risk factors but with a giant solitary coronary aneurysm with obstructive thrombosis inside, presumably secondary to KD, who underwent coronary artery bypass grafting [CABG] with left internal thoracic artery [LITA] and SVG. Because coronary artery sequelae of KD can be a cause of ischemic heart disease even in young adults, heightened awareness of this entity is required for young adults with coronary lesions but without coronary risk factors