ABSTRACT
Bifurcated anastomosis is a technique wherein geometrically tailored flaps of a vein graft are anastomosed to an arteriotomy in a vessel and its two branches. Although this technique may be useful for the surgical management of any diseased arterial bifurcation, it is particularly valuable in coronary endarterectomy or when complete revascularization of a coronary artery with proximal and bifurcation disease would otherwise require three separate bypass grafts.
Subject(s)
Arteriovenous Shunt, Surgical/methods , Coronary Artery Bypass/methods , Suture Techniques , Coronary Disease/surgery , Endarterectomy , HumansABSTRACT
As more high-risk patients undergo percutaneous transluminal coronary angioplasty (PTCA), the changing profiles of PTCA patients who may require emergent coronary artery bypass grafting may alter operative morbidity and mortality. This study compared profiles of recent patients undergoing emergent coronary artery bypass grafting after a failed PTCA with earlier patients to determine their impact on operative results. From 1980 to 1988, 53 patients underwent emergent coronary artery bypass grafting after a failed PTCA at the Boston University Medical Center. These patients were divided into two groups based on the year of the PTCA: group I, 1980 to 1985 (n = 18); and group II, 1986 to 1988 (n = 35). Group II patients tended to be older (age greater than or equal to 65 years, 47% group II versus 11% group I), were more likely to have unstable angina before PTCA (74% versus 33%), and had lower ejection fractions (0.53 +/- 0.02 versus 0.63 +/- 0.05) and more vessels with 50% or greater stenosis (2.1 +/- 0.2 versus 1.6 +/- 0.2). Nevertheless, there was no significant difference in the incidence of perioperative myocardial infarcts using enzyme and electrocardiographic criteria (37% in group II versus 39% in group I), 30-day operative mortality (11% in group II versus 11% in group I), or major postoperative complications (14% in group II versus 22% in group I). We conclude that despite the changing profiles of patients undergoing PTCA, which include older patients with more extensive coronary artery disease and lower ejection fractions, operative results after emergent coronary artery bypass grafting for failed PTCAs remain unchanged.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Artery Bypass , Coronary Disease/surgery , Age Factors , Aged , Combined Modality Therapy , Coronary Disease/pathology , Emergencies , Female , Humans , Male , Middle Aged , Myocardial Revascularization , Postoperative Complications , Time FactorsABSTRACT
A 77-year-old man with a history of renal cell carcinoma presented with orthostatic syncope. Investigation revealed metastatic carcinoma in the left lung extending through the pulmonary veins into the left atrium obstructing the mitral orifice. On review of the literature, this case appears to be the first to describe metastatic carcinoma to the left atrium presenting as a primary cause of syncope.
