Left upper lobectomy after CABG with the left internal mammary artery graft.

Left upper lobectomy in a patient with a history of Left Internal Mammary Artery (LIMA) graft for Coronary Artery Bypass Graft surgery (CABG) is a challenge for the surgical team. The adhesion formation in the left chest, especially around the left internal mammary artery graft, may cause diffculty for surgery. The injury of LIMA during dissection may lead to serious acute myocardial ischemia and cardiac arrest. The authors reported a case of successful operation after receiving both good surgical and anesthetic plan prior to surgery.

Immediate and early results of mitral valve repair at King Chulalongkorn Memorial Hospital.

OBJECTIVE: Comparison with prosthesis mitral valve replacement, mitral valve repair has lots of advantages. After valve repair, patients have better left ventricular function, a lower rate of thromboembolism and infective endocarditis. The authors studied early experience of mitral valve repair. MATERIAL AND METHOD: From January 2000 to May 2002, 43 consecutive patients with mitral regurgitation had mitral valve repair. Valve disease was degenerative in 51.2 per cent, ischemic in 18.7 per cent, rheumatic in 13.9 per cent, infectious in 11.6 per cent, and others in 4.6 per cent. Surgical techniques included P2 quadrangular resection (n = 13; 30.95%), chordal tranfer (n = 11; 26.19%), only annuloplasty (n = 10; 23.8%), artificial chordae (n = 3; 7.14%), commissural closure (n = 3; 7.14%), and others in 2 cases (4.76%). RESULT: Immediate post-operative echocardiogram showed no or trivial regurgitation in 95 per cent and moderate regurgitation in 5 per cent. There was no operative mortality, but 1 case had hospital mortality with 1-24 months follow-up, 90 per cent of cases had FC I and the other (10%) were in FC II. CONCLUSION: This preliminary experience provided promising immediate and early result. The authors believe that mitral valve repair is safe and seems to have a much better result than mitral valve replacement. However, a randomized control study and long-term follow-up, in the future, are important.

Bilateral carotid stenting prior to coronary artery bypass graft: a case report.

BACKGROUND: Carotid stenosis is an independent possible complication of the central nervous system of patients after receiving a coronary artery bypass graft (CABG). The risk increases when the patient has bilateral carotid stenosis even if asymptomatic. CASE REPORT: A 76 year-old female was admitted because of unstable angina. The coronary angiography showed triple vessel disease and required CABG for revascularization. Her physical examination revealed bilateral carotid bruits. She did not have any history of neurological deficit. Carotid Doppler showed critical stenosis of bilateral carotid arteries. The carotid angiography demonstrated 70 per cent diameter stenosis of both internal carotid arteries just above the bifurcation of the external carotid artery. A 7 x 20 mm self-expandable Smart stent was implanted first in the right carotid artery with good angiographic result. Five days later, another 7 x 20 mm self-expandable Smart stent was implanted in the left carotid artery without residual stenosis. The patient did not have any cardiovascular complications. CABG was performed 2 weeks later with a good result. The patient was discharged 10 days after CABG. CONCLUSION: Bilateral carotid stenting is feasible and produces an acceptable outcome. This procedure is an alternative treatment for preventing stroke during CABG surgery.