Midterm follow-up of patients receiving radial artery as coronary artery bypass grafts using 16-detector-row CT coronary angiography.

PURPOSE: The study was undertaken to evaluate the 3-year outcome of patients undergoing coronary artery bypass grafting (CABG) involving the use of the radial artery (RA) in comparison with the left internal mammary artery (LIMA) and saphenous vein (SV) grafts by using 16-slice multidetector computed tomography (MDCT). MATERIALS AND METHODS: Fifty-one patients underwent electrocardiogram (ECG)-gated 16-MDCT 32+/-4 months after surgery. A total of 50 LIMA grafts, 55 SV grafts and 51 RA grafts were studied. Approximately 68.6% or RAs were free, 21.5% sequential and 9.8% composite. Grade 0 was defined as complete patency, grade 1 as focal stenosis (>70%) and grade 2 as graft occlusion. The Fisher exact test was used to analyse variables (p<0.05 significant). Concordance between readers for the detection of patency was calculated by the kappa-value. RESULTS: LIMA had the best patency rate (94.0%), followed by SV (83.6%) and RA (74.5%). Regarding RA, the patency rate by territory was 79.4% in the left circumflex coronary artery (LCX), 72.7% in the left anterior descending (LAD) and 50% in the right coronary artery (RCA); the occlusion rate was 20.0% among free grafts, 18.2% among sequential grafts and 20.0% among composite grafts. The kappa-value was 0.86. CONCLUSIONS: Sixteen-slice MDCT scanners enable accurate analysis of CABG status and are a useful noninvasive diagnostic tool for midterm clinical follow-up of patients who have undergone CABG involving the use of RA.

Retrograde cerebral perfusion for aortic operations through left thoractomy.

Retrograde cerebral perfusion during deep hypothermic circulatory arrest is a technique used largely during operations on the ascending aorta, aortic arch, or both through a median sternotomy. This method is not frequently used for operations performed through a left thoracotomy because of problematic access to the right side of the heart. We propose a technique allowing retrograde cerebral perfusion through a left thoracotomy in a quick, simple, and efficient manner.

Left ventricular aneurysm secondary to Behçet's disease.

A 16-year-old boy with Behçet's disease who was seen with thrombophlebitis of the leg was found to have coronary artery occlusion with postinfarction left ventricular aneurysm. Recurrent femoral artery aneurysms and orogenital ulceration developed in him. The diagnostic features together with successful treatment of this patient and a discussion of Behçet's syndrome are presented.

Central shunt and pulmonary valvotomy in the treatment of critical pulmonary stenosis.

Pulmonary valvotomy combined with a central shunt ("U shaped" Gore-tex graft) for palliative treatment of critical pulmonary stenosis is reported. The same graft was employed for right ventricular outflow reconstruction at the time of the definitive repair.

Anomalous origin of right pulmonary artery from the ascending aorta.

Anomalous origin of one pulmonary artery from the ascending aorta without associated intracardiac defects is a rare congenital malformation. About 60 anatomic and surgical descriptions have been reported in the literature. Up to 1974, 22 of the 50 reported cases underwent surgical correction with a 40% mortality rate. The natural history without surgery is poor with a very high mortality during the first year of life. Successful anatomic correction of anomalous origin of right pulmonary artery from the ascending aorta in a 6 months old female is reported.

Cardiorespiratory effects of protamine sulphate in man: intra-aortic vs intra-right atrial rapid administration after cardiopulmonary bypass.

The effects of protamine sulphate on several cardiorespiratory variables were studied under clinical situations in twenty patients following cardiopulmonary bypass. Because recent reports suggest that there may be advantages of intra-aortic versus intra-venous administration we prospectively evaluated cardiorespiratory features 1 and 10 minutes after rapid administering of protamine sulphate either into the aortic arch (through a catheter percutaneously inserted via the radial artery for monitoring purposes) or into the right atrium. Significant variations in some parameters were found in the patients receiving the drug via the aorta, such as a drop of systemic vascular resistances (p less than 0.05), of coronary perfusion pressure (p less than 0.05), of aortic systolic pressure (p less than 0.01), of diastolic (p less than 0.01) and mean blood pressure (p less than 0.05) and a rise in the respiratory quotient (p less than 0.05). It is concluded that the results do not confirm the superior safety of intra-aortic administration of protamine particularly when replenishment of intravascular volume is not provided.