[Simultaneous operation of off-pump coronary artery bypass grafting and Y-grafting through median laparotomy incision; report of a case].

A 57-year-old man with both coronary artery disease and iliofemoral occlusive lesions was successfully operated with a combined revascularization procedure. Through a median laparotomy incision, off-pump coronary artery bypass grafting (OPCAB) using the right gastroepiploic artery and aorto-bifemoral bypass were performed simultaneously. The patient recovered well and experienced neither angina nor intermittent claudication.

Retrograde crossing through the pedal arch for totally occluded tibial artery.

Critical limb ischemia is characterized by atherosclerotic disorder of the crural arteries. The occlusion of dorsalis pedis and paramalleolar posterior tibial arteries is a rare atherosclerotic pattern in the crural arteries. We present a successful case of retrograde posterior tibial artery crossing through the pedal arch after antegrade recanalization of occluded anterior tibial and dorsalis pedis arteries, leading to the achievement of complete infrapopliteal recanalization and wound healing.

Pacemaker system replacement under local anesthesia allowing MRI access 7 years after the initial surgery: Two case reports.

Background: Older pacemaker systems, which are magnetic resonance imaging (MRI) incompatible, require replacement with compatible systems when patients are in need of MRI. Replacement involves extraction of the pacing lead, which is usually done with a laser sheath under general anesthesia. Case presentation: We report two cases of complete pacing system replacements allowing patient access to MRI. Both replacements were made under local anesthesia and without the use of special devices over 6 years after the initial surgery. Both replacements used retractable screw-in leads with a cut-down of cephalic or external jugular veins performed during the initial surgeries. Case 1 involved a 79-year-old man with cerebral ischemia, and case 2 involved a 70-year-old man with spinal canal stenosis. Conclusion: With careful management, it is possible to replace an entire pacing system under local anesthesia without additional devices.

A stand-up collar around the saphenous vein graft.

We present a technique of a stand-up collar around the saphenous vein graft using a pedicled fat pad flap. This procedure is simple and effective to avoid kinking in a graft that was proximally anastomosed with an automatic device and to maintain the graft in its natural position.

Surgical resection of cardiac papillary fibroelastoma in the left ventricular outflow tract.

An 81-year-old man was referred to our hospital on May 29, 2006, for a left ventricular tumor that a cardiologist had evaluated by echocardiography. The patient underwent surgical resection of a left ventricular tumor including the stalk through the aortic annulus on June 6. The aortic cross-clamp time, cardiopulmonary time, and operation time were 27 minutes, 48 minutes, and 2 hours 40 minutes, respectively. The specimen was examined pathologically and found to be a cardiac papillary fibroelastoma (CPF), 20x15 mm in size. He was discharged home 10 days after the surgery without significant adverse events. There are approximately 6 case reports on CPF in the left ventricular cavity published in Japan. Our surgical experience was reported, and a clinical feature of papillary fibroelastoma on the prior clinical data was reviewed retrospectively.

Ultrasonographic measurement of intima-media thickness of the carotid artery before coronary artery bypass grafting.

PURPOSE: We evaluated the usefulness of measuring intima-media thickness (IMT) of the carotid artery by ultrasonography before coronary artery bypass grafting (CABG). METHODS: Seventy-three patients who underwent carotid ultrasonography before CABG were selected for this study. The maximum IMT (max IMT) in the bilateral common carotid artery was used as the index of carotid ultrasonography. As a quantitative measure of coronary atherosclerosis, we calculated Gensini's coronary score (GCS) from the preoperative coronary angiography. RESULTS: There was a positive correlation between the max IMT and the GCS. Furthermore, the max IMT of the patients with myocardial infarction was significantly greater than that of the patients with angina pectoris. CONCLUSIONS: Carotid ultrasonography before CABG is useful, not only for the morphological evaluation of the stenotic lesions of the neck vessels, but also for the quantitative prediction of atherosclerosis in the native coronary artery. The max IMT may predict the progression of atherosclerotic change of the native coronary artery from angina pectoris to myocardial infarction.