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1.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 207-210, 2017.
Artículo en Inglés | WPRIM | ID: wpr-111245

RESUMEN

The extracardiac conduit Fontan procedure is the last surgical step in the treatment of patients with a functional single ventricle. An acquired pulmonary arteriovenous malformation may appear perioperatively or postoperatively due to an uneven hepatic flow distribution. Here we report a case of a bifurcated Y-graft Fontan operation in a 15-year-old male patient with a unilateral pulmonary arteriovenous malformation after an extracardiac conduit Fontan operation.


Asunto(s)
Adolescente , Humanos , Masculino , Malformaciones Arteriovenosas , Procedimiento de Fontan , Cardiopatías Congénitas , Enfermedades Vasculares
2.
Korean Journal of Hepato-Biliary-Pancreatic Surgery ; : 61-65, 2016.
Artículo en Inglés | WPRIM | ID: wpr-81489

RESUMEN

Anomalous portal vein (PV) branching of the donor liver is uncommon and usually makes two, or rarely, more separate PV branches at the right liver graft. Autologous PV Y-graft interposition has long been regarded as the standard procedure, but is currently replaced with the newly developed technique of conjoined unification venoplasty (CUV) due to its superior results. Herein, we presented a case of CUV application to three PV openings of a right liver graft. The recipient was a 32-year-old male patient with hepatitis B virus-associated liver cirrhosis. The living liver donor was his 33-year-old sister who had a type III PV anomaly, but the right posterior PV branch was bifurcated early into separate branches of the segments VI and VII, thus three right liver PV branches were cut separately. We used the CUV technique consisting of placement of a small vein unification patch between three PV orifices, followed by overlying coverage with a crotch-opened autologous portal Y-graft. The portal Y-graft was excised and its crotches were incised to make a wide common orifice. Three bidirectional running sutures were required to attach the crotch-opened autologous portal Y-graft. After portal reperfusion, the conjoined PV portion bulged like a tennis ball, providing a wide range of alignment tolerance. The patient recovered uneventfully from the liver transplantation operation. The CUV technique enabled uneventful reconstruction of triple donor PV orifices. Thus, CUV can be a useful and effective technical option for reconstruction of right liver grafts with various anomalous PVs.


Asunto(s)
Adulto , Humanos , Masculino , Hepatitis B , Cirrosis Hepática , Trasplante de Hígado , Hígado , Vena Porta , Reperfusión , Carrera , Hermanos , Suturas , Tenis , Donantes de Tejidos , Trasplantes , Venas
3.
Artículo en Inglés | IMSEAR | ID: sea-168262

RESUMEN

In common practice, left internal mammary artery (LIMA) along with great saphanous vein is used in coronary artery bypass grafting (CABG). Day by day total arterial CABG specially use of bilateral mammary arteries are becoming demanding. Coexisting occlusive disease may rarely affect coronary arteries along with left subclavian artery. We have reported a successful concomitant aorto-axillary bypass and CABG of a 52-year-aged man with the diagnosis of triple-vessel-disease (TVD) angiographically along with proximal stenosis in left subclavian artery. Aorto-axillary (left) bypass was done with 6-mm ring re-inforced polytetrafluoroethane (PTFE) graft and CABG was done by total arterial RIMA-LIMA “Y” graft on beating heart. The post-operative course was uneventful with reappearance of peripheral pulses in left upper extremity. The patient was discharged on the 9th post-operative day.

4.
Japanese Journal of Cardiovascular Surgery ; : 368-371, 2008.
Artículo en Japonés | WPRIM | ID: wpr-361867

RESUMEN

The excellent long term-patency rates achieved using the internal thoracic arteries (ITAs) have expanded the variety of graft arrangements of these conduits for multivessel coronary revascularization. We encountered 2 patients who underwent multivessel coronary artery bypass, by using these terminal branches of the left ITA effectively. In both patients, LITAs were taken down using the skeletonization technique with a harmonic scalpel. One patient had 2 grafts using the off-pump technique with the Y-composite grafts constructed by the main LITA trunk and LITA terminal branch, which were anastomosed with the left anterior descending branch (LAD) and diagonal branch (D<sub>1</sub>), respectively. The other patient had 6 grafts under on-pump cardiac arrest, including the natural LITA terminal branches which were anastomosed with the LAD and D<sub>1</sub>. Postoperative multidetector computed tomography (MDCT) revealed excellent long-term patent grafts in both patients. In conclusion, the terminal branches of the ITA, if of suitable size and length, could be used effectively to construct a Y-anastomosis for the coronary arteries, when consideration for the size of the target coronaries and native-coronary blood flow competition.

5.
Journal of Huazhong University of Science and Technology (Medical Sciences) ; (6): 82-85, 2006.
Artículo en Chino | WPRIM | ID: wpr-266450

RESUMEN

The feasibility and safety of total arterial coronary revascularization with 2 arterial conduits in patients with impaired left ventricular function was evaluated. Data were prospectively collected on all patients with multiple vessel disease and moderately or severely impaired left ventricular function, who underwent coronary surgery with the intention of total arterial revascularization with 2 conduits between March 1995 and August 2002. One hundred and seventy-nine patients were included in the study. Acute coronary insufficiency was present in 3 patients and 43 had unstable angina. Severe left ventricular impairment was present in 29 patients. There were 17 redo operations including 3 redo-redo procedures. Eighty-two percent of patients had a Y graft configuration from the left internal mammary artery (right internal mammary artery 40. 8 %, radial artery 33.5 %,other 7.8 % ). The perioperative mortality was 2.2 %, myocardial infarction 1.7 % and stroke 0. 6 %.Total arterial revascularization in patients with ischaemic left ventricular dysfunction can be safely performed with 2 arterial conduits. The radial artery provides conduit length greater than the right internal mammary artery and allows full revascularization despite left ventricular dilatation.

6.
Japanese Journal of Cardiovascular Surgery ; : 98-102, 2005.
Artículo en Japonés | WPRIM | ID: wpr-367065

RESUMEN

We treated 162 patients by isolated CABG with a left internal thoracic artery (LITA) anastomosed to the left anterior descending artery and a radial artery anastomosed to the circumflex artery between August 1996 and December 2002. Late angiograms were performed 6 to 65 months (21.7±15.8) after the operation. The purpose of this study was to compare midterm results of radial arteries anastomosed to the side wall of LITA (group Y) with those anastomosed to the aorta (group AC). There were no operative deaths in either group and no difference in the postoperative complication rate including cerebral infarction. The early patency of group Y was lower than that of group AC (group AC: 97.8%, group Y: 87.1%, <i>p</i>=0.017), and also the late patency of group Y was significantly lower than that of group AC (group AC: 90.9%, group Y: 36.4%, <i>p</i>=0.0008). All of the early patent radial artery grafts in group AC were patent on late angiograms, but 3 of the 25 anastomoses in group Y which were clearly patent on early angiograms later showed a string sign later. When using a radial artery graft in circumflex artery territory, we recommend an aorto-coronary bypass graft rather than Y-graft.

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