Surgical treatment of a giant left main aneurysm.

Coronary artery aneurysms are a rare finding and even more any coronary dilation having a diameter 1.5 times greater than the adjacent artery qualified as giant. No established treatment protocol exists. We report the case of a 75-year old man with a clinical symptom of chest pain on exertion, worsening in the last 6 months, who was diagnosed with a giant left main aneurysm. Surgical ligation of the proximal left anterior descending artery and first diagonal and triple bypass, using saphenous vein graft to vascularize the proximal circumflex artery, left anterior descending artery and first diagonal, was performed.

Thymic carcinoma presenting as atypical chest pain.

A 58-year-old woman with a 2-month history of atypical chest pain was referred to the chest pain clinic by the general practitioner. Exercise stress test was positive and subsequent coronary angiogram revealed significant triple vessel disease with left ventricular impairment requiring a coronary artery bypass graft (CABG). The patient had a chest X-ray as part of the preoperative work up. Chest X-ray revealed a large anterior mediastinal mass. Subsequent thorax CT revealed a 7.2 cm anterior mediastinal mass. CT-guided biopsy of the mass revealed the diagnosis of a poorly differentiated thymic basaloid carcinoma. The patient was successfully treated with concomitant surgery involving complete resection of the mass and a CABG procedure.

Sternal Talon, a novel repair for sternal dehiscence.

Sternal dehiscence is a recognised complication after median sternotomy, occurring in 0.5-5% of cases with or without infection. A 72-year-old man presenting with collapse and ventricular tachycardia was investigated for a possible acute cardiac event 2 years after coronary artery bypass grafting for ischemic heart disease. Work-up chest X-ray showed displacement of all sternal wires, and computed tomography (CT) performed to investigate further showed sternal dehiscence with right ventricle wall herniation through the defect and sternal wire breakdown. A decision was made after discussion with the patient to repair the defect using 3 Sternal Talon devices and 2 sternal wires. The patient made an uncomplicated recovery, and the outpatient clinic review after discharge home showed satisfactory and stable sternal union. We report a case of non-infected sternal dehiscence managed successfully with the Sternal Talon without long-term complications.

[Surgical treatment and adjunct hyperbaric therapy to improve healing of wound infection complications after sterno-mediastinitis]. / Leczenie chirurgiczne skojarzone z tlenoterapia hiperbaryczna powiklanego gojenia sie rany z zapaleniem sródpiersia i kosci mostka.

UNLABELLED: Although the incidence of wound complications after median sternotomy is less than 1%, it remains a serious complication in patients undergoing cardiac procedures. We suggest that the combination of hyperbaric oxygen therapy and aggressive surgical approach improves clinical outcomes in these patients. Between August 1997 and May 2002, 55 patients with postoperative sternal wound infection and/or mediastinitis were qualified for hyperbaric oxygen treatment in connection to surgical management. Surgical procedure included wound debridment and/or sternum rewiring, omental pedicle flap plasty or sternectomy. Hyperbaric oxygen therapy consisted of 20 to 40 expositions per patient and was carried before and after the surgery. RESULTS: There was no in-hospital death. The total time between the admission and discharge from the hospital varied from 2 to 24 weeks (average 8 weeks). The infection has been cured in all patients treated for postoperative sternal wound infection. That has been confirmed by negative bacteriological tests, stabilization of the sternum and complete wound healing. CONCLUSIONS: The combination of surgical treatment and hyperbaric oxygen therapy may improve clinical outcome in patients with sterno-mediastinis and poststernotomy wound infection after cardiac surgery.

[Myocardial revascularization without extracorporeal circulation in patients with ischemic impaired left ventricular contraction]. / Pomostowanie naczyn wiencowych bez krazenia pozaustrojowego u chorych z poniedokrwiennym uposledzeniem czynnosci skurczowej lewej komory.

Coronary bypass graft procedures still remain a surgical challenge in patients with severe left ventricular dysfunction. The study was designed to compare off pump myocardial revascularization with conventional bypass procedures in patients with ejection fraction below 35%. Our results suggest that in selected patients off pump bypass procedure, may be used as a suitable and safe alternative to conventionalon pump coronary surgery, permitting complete revascularization with comparable short-term results.

[Thermographic monitoring of of the left anterior descending coronary artery bypass without extracorporeal circulation, but using stabilizing procedures. Case report]. / Termograficzne monitorowanie pomostowania galezi przedniej zstepujacej lewej tetnicy wiencowej bez krazenia pozaustrojowego z zastosowaniem stabilizatora mechanicznego. Opis przypadku.

During the coronary artery bypass off pump procedure thermal angiography was evaluated for the intraoperative assessment of the patency and the flow in the left internal mammary to the left anterior descendens. Our observation confirms that thermal angiography may be used as an intraoperative method which improves graft quality control during coronary bypass procedures.

[Evaluation of bypass patency in the radial artery with intermediate term observation]. / Ocena droznosci pomostu z tetnicy promieniowej w obserwacji srednioodleglej.

After an initial learning experience in the early 70's, radial artery is now used as the second arterial graft of choice (after both ITAs). The aim of the study was to compare patency rates of venous and arterial grafts--especially radial artery--in mid-term follow up period. 19 patients with stable angina and 11 with unstable angina underwent coronary artery bypass grafting with CPB. The type of conduits used for grafting were the same in all patients. All patients underwent catheterization control. 28 LIMA grafts and 27 radial artery grafts were patent 31 months after CABG. Vein grafts were found patent in 80%.

Off-pump coronary artery bypass surgery--initial experience in Gdansk: a brief review.

BACKGROUND: Before the introduction of cardiopulmonary bypass (CPB), coronary artery bypass grafting (CABG) procedures were performed on a beating heart. In 1967, Kolessov first reported "off-pump" revascularization of the left anterior descending artery (LAD). This technique was later abandoned when the use of cardioplegia and the heart-lung machine allowed a motionless and bloodless operative field. This study reports our initial clinical experience in off-pump coronary bypass surgery performed at the Department of Cardiac Surgery of the Medical University of Gdansk, Poland. METHODS: This study enrolled all consecutive patients who were operated on at our institution without CPB between January 1998 and December 2001. Patients were selected for the off-pump procedure individually by the surgeon. Demographics, operative procedures, postoperative mortality, morbidity, and early outcomes were analyzed. The observation period included 30 postoperative days. RESULTS: An average of 1.8 grafts per patient were completed. Conversion to CPB was required in 4.1% of patients. Complete revascularization was attained in 91% of the procedures. Surgical mortality was 1.3% and perioperative myocardial infarction was reported in 2.4%. CONCLUSIONS: In selected patients, off-pump CABG may be used as a suitable and safe alternative to conventional on-pump coronary surgery and permits complete revascularization with comparable short-term results.