Off-Pump coronary revascularization using bilateral internal thoracic arteries in a patient with paroxysmal nocturnal hemoglobinuria: a case report

Abstract Paroxysmal nocturnal hemoglobinuria (PNH) is an ultra-orphan disease. We report the first case in the literature of Off-Pump Coronary Revascularization Using Bilateral Internal Thoracic Arteries in a patient with paroxysmal nocturnal hemoglobinuria. A 36-year-old man came to the emergency department with acute non-ST elevation myocardial infarction (NSTEMI). He presented paroxysmal nocturnal hemoglobinuria diagnosed in 2016. Coronary angiography revealed tripple vessel disease. The conduits used for coronary revascularization were both internal thoracic arteries (left ITA-right ITA [LITA-RITA]). We consider that off-pump coronary artery bypass grafting (OPCABG) using Bilateral Internal Thoracic Arteries (BITA) can be safely performed with low in-hospital mortality and complications rates, even in patient with PNH.

Discovery of a Clandestine Ticking Bomb - Blunt Traumatic Aortic Injury

@#Blunt traumatic aortic injury (BTAI) is a crucial diagnosis to be made early in the management of trauma patients with aims to improve survival outcome. The objective of this case report is to highlight and explore the role of imaging especially Computed Tomography Angiography (CTA) thorax to diagnose a focal traumatic aortic isthmus pseudoaneurysm in a young gentleman sustaining high impact thoracic trauma.

Thoracic dorsal artery perforating flap transplantation under high-frequency ultrasound guidance / 中国组织工程研究

BACKGROUND:The most advanced and representative diagnosis techniques for perforating branch of blood vessels include digital subtraction angiography, CT, MRI and other imaging techniques. These methods can visualize blood vessels clearly and have a high precision, but there are some trauma and less popular. OBJECTIVE:To apply high-frequency ultrasound for detection of thoracic dorsal artery and perforating branch, and provide a reference for preoperative design of thoracic dorsal artery perforating flap. METHODFifteen patients candidate for thoracic dorsal artery perforating flap were included in this study. Before surgery, we used high-frequency ultrasound to detect the perforating branch, including vascular contorts, diameter, the location of the perforators and surface markers. The thick, superficial, paral el perforating branch was selected as the main blood vessels, to design and cur the skin flap. RESULTS AND CONCLUSION:In the involved 15 cases, thoracic dorsal artery were derived from the subscapular artery, thoracic dorsal artery and its main branches, as wel as more than 1 mm main perforating branch in 13 cases were clearly visible. It was consistent with intraoperative measurement results. The perforating branch less than 1 mm only showed strip-like blood flow signal or no blood flow and spectrum signal, and there was an unclear boundary to surrounding tissue. One case appeared distortion and variation of blood vessels before surgery, thus changed to other surgery. Two cases had no perforating branch by preoperative detection, which was then confirmed by intraoperative anatomy. High-frequency ultrasound has a significant effect on preoperative position of perforating branch, and the combination with computer tomography angiography and magnetic resonance angiography can support a more comprehensive and reliable reference.

The Value of 256-Slice Spiral CT Angiography in Internal Thoracic Artery / 天津医药

Objective To study the value of 256-slice spiral CT (MSCT) in internal thoracic artery. Methods The angiographic images of 107 patients who were suspected thoracic and abdominal aortic diseases were retrospectively ana-lyzed. The running rule and branches of internal thoracic artery on both sides were observed. Each side of the internal thorac-ic artery was divided into 3 sections according to the running rule. The lumen diameter, vessel length and its branches were measured in three segmental vascular of the internal thoracic artery. The lumen diameter of the diaphragmatic artery diame-ter,and the distance between internal thoracic artery and each border of the sternum were also measured. Results Both sides of the internal thoracic and diaphragmatic arteries were shown in 107 patients (100%). There were significant differenc-es in vascular lumen diameter of intrathoracic artery of both sides (P＜0.05). There were no significant differences between both sides of the corresponding segments (P>0.05). The left internal thoracic artery was significantly longer in the left side than that of right side (P＜0.05). There were no significant differences between the diameter of diaphragmatic arteries and the distance between the internal thoracic artery and the sternal edge of two sides (P>0.05). Conclusion The application of 256-slice spiral CT angiography can clearly show the running rule and anatomical features of internal thoracic artery ,and provide a relatively important clinical information.

Does Bilateral Pedicle Internal Thoracic Artery Harvest Increase the Risk of Mediastinitis?

PURPOSE: Bilateral in situ internal thoracic artery (ITA) bypassing may result in excellent myocardial revascularization without increasing the risk of deep sternal wound infection. Although there have been concerns with the use of pedicled bilateral ITA, the risk of infection may not be greater than the use of skeletonized ITA. MATERIALS AND METHODS: The present study was retrospectively undertaken to determine if pedicled BITA grafts are associated with a higher risk of sternal wound complications. A total of 207 patients who underwent bilateral ITA bypasses with or without existing diabetes mellitus, and 162 patients of those received bilateral pedicled ITA and 98 patients received unilateral ITA bypass grafts. RESULTS: No sternal wound complications were noted in either the bilateral ITA or unilateral left ITA groups. CONCLUSION: Bilateral pedicled ITA harvesting was not associated with a greater incidence of infectious sternal complications compared to patients receiving unilateral ITA bypass grafts.

Surgical myocardial revascularization: off-pump use of bilateral internal thoracic artery grafting / Cirurgia de revascularização miocárdica: uso de enxerto bilateral de artéria torácica interna sem circulação extracorpórea

FUNDAMENTO: Avanços na cirurgia de revascularização miocárdica (RM) introduziram benefícios adicionais, como a técnica sem uso da circulação extracorpórea (CEC) e a utilização do enxerto bilateral de artéria torácica interna (ATI). A cirurgia de RM sem uso da CEC tem sido associada a melhora dos resultados imediatos e a redução da incidência de complicações perioperatórias, e o uso bilateral de enxertos de ATI oferece aumento de sobrevida e redução de eventos cardiovasculares a longo prazo. OBJETIVO: Apresentar a experiência inicial com o emprego combinado desses avanços na cirurgia de RM. MÉTODOS: Foram estudados 35 pacientes consecutivos submetidos a RM sem CEC, com enxertos bilaterais de ATIs, sendo a ATI esquerda dirigida para a artéria descendente anterior e a ATI direita anastomosada aos ramos da artéria circunflexa. As co-morbidades predominantes foram infarto do miocárdio prévio em 71,4 por cento dos pacientes, diabetes melito em 34,2 por cento e insuficiência renal em 14,2 por cento. RESULTADOS: Nenhum paciente apresentou alteração do eletrocardiograma ou elevação enzimática no pós-operatório. O número de pontes por paciente variou de 2 a 4 (mediana de 3 pontes/paciente). A permanência hospitalar pós-operatória esteve entre 3 e 12 dias (média de 4,7 + 1,7 dias). Não houve casos de infecção ou deiscência esternal, mas um paciente apresentou acidente vascular cerebral no quarto dia de pós-operatório e faleceu. A duração do seguimento tardio foi de 4 a 48 meses. Não houve óbitos tardios, 31 pacientes estão assintomáticos e 3 têm angina residual. CONCLUSÃO: A combinação desses avanços técnicos na cirurgia de revascularização cirúrgica mostrou-se eficaz e pode contribuir para a melhora dos benefícios a longo prazo.

BACKGROUND: Advances in surgical myocardial revascularization (MR) have introduced additional benefits with the off-pump (OP) technique and the use of bilateral internal thoracic artery (ITA) grafting. Off-pump surgical MR has been associated with improved immediate outcomes and reduced incidence of perioperative complications, and the use of bilateral ITA grafts provides increased survival and decreased cardiovascular events in the long term. OBJECTIVE: To present the initial experience with the combined use of these advances in surgical MR. METHODS: A total of 35 consecutive patients undergoing off-pump MR with bilateral ITA grafting were studied; the left ITA was directed toward the anterior descending artery and the right ITA was anastomosed to the circumflex artery branches. The predominant comorbidities were previous myocardial infarction in 71.4 percent of the patients, diabetes mellitus in 34.2 percent, and renal failure in 14.2 percent. RESULTS No patients presented electrocardiographic changes or enzyme elevation in the postoperative period. The number of bypasses per patient ranged from two to four (median of three bypasses/patient). Postoperative hospital stay ranged from three to 12 days (mean of 4.7 + 1.7 days). No cases of sternal dehiscence or infection were observed, but one patient suffered a stroke on the fourth postoperative day and died. Late follow-up lasted from four to 48 months. No late deaths occurred, 31 patients are asymptomatic, and three have residual angina. CONCLUSION: The combination of these technical advances in surgical myocardial revascularization proved efficient and able to contribute to improved benefits in the long term.

Uso das artérias torácicas internas esquerda e direita na revascularização da artéria coronária esquerda / The Left and Right Internal Thoracic Arteries Grafts for Revascularization of the Left Coronary Artery

PURPOSE: To analyze the late results of patients who underwent left coronary myocardial revascularization with both internal thoracic arteries, with the right internal thoracic through the transverse sinus. METHODS: From July/83 to September/96, 233 patients underwent myocardial revascularization, with ages ranging from 35 to 76 (average of 52.8) years. One hundred and eighty five were male and 48 female. Internal thoracic arteries (466), saphenous veins (192) and epigastric arteries (11) were employed. RESULTS: The hospital mortality was 3and the late mortality was 6.1. The immediate postoperative bleeding was 0.8, mediastinitis 1.7and myocardial infarction 2.1. The immediate and late coronariography showed the rates of patency, respectively: left internal thoracic artery 98and 96, right internal thoracic artery 96and 92, and saphenous vein grafts 80and 67.5. CONCLUSION: The main advantage in using both internal thoracic arteries in the revascularization of the left coronary branches was the better quality of life, the low rates of cardiac events and the absence of reoperation due to occlusion of the grafts.

The relaxing effect of Kouzilan on isolated thoracic aortic ring of SD rat / 中国病理生理杂志

Kouzilan was selected as a potent hypotensive drug, and two fractions, K01 (hydrosoluble element) and K02 (fat-soluble element), were extracted from it. Thepresent study focused on its mechanism of vascular effects in vitro. The data showed thatK01 and K02 antagonized the contraction of isolated thoracic aortic ring of SD rat, indu-ced by norepinephrine (NE, 1 ?mol/L). The IC_(50) values of K01 and K02 were 1.98g/Land 1.15g/L respectively, and that of Verapamil (Ver) was 0.88 ?mol/L. K01, K02 andVer all shifted the dose-response curves of NE to the right in a noncompetitive antagonis-tic manner, and they also depressed the maximal efficacy of contraction. Added NE intoa calcium-free K-H solution to induce aortic vessel contraction (phase 1), then added cal-cium (2.5mmol/L) to induce continued contraction (phase 2), K01 depressed phase 2significantly. In lower concentration, K02 was similar to K01, however, in higher concen-tration, it depressed phase 1 and phase. 2 significantly, which was similar to Ver. Theseresults suggested that K01 and K02 had a vasodilative effect, which was related to theblockade of the receptor operated calcium channel (ROC). K02 inhibited both the calciumrelease from intracellar storage sites and the influx of extracellar calcium, but K01 onlyinhibited the latter.