Minimal dissection and continuous retrograde cardioplegia for aortic valve replacement in patients with a patent left internal mammary artery bypass graft.

BACKGROUND AND AIM OF THE STUDY: Aortic valve replacement (AVR) in patients with previous coronary artery bypass grafting (CABG) and a patent pedicled internal mammary artery (IMA) is often complicated by a need to dissect and clamp the IMA to achieve optimal myocardial protection. Eliminating this need may simplify and facilitate surgery; hence, a new surgical technique for use in these patients is described. METHODS: Five patients with previous CABG and functioning IMA who required AVR between January 1998 and October 2002 were studied. In all patients, the IMA was neither dissected nor clamped. Myocardial protection comprised an initial bolus of antegrade cardioplegia, followed by continuous retrograde infusion of tepid non-diluted oxygenated blood, supplemented with cardioplegic drugs to maintain cardiac arrest. The systemic and myocardial temperature was 30-32 degrees C. RESULTS: All patients underwent surgery as planned, and there was no operative mortality or myocardial infarction. One patient sustained a minor stroke. None of the IMA was injured. CONCLUSION: In patients requiring AVR, it is both possible and reasonable to leave the IMA undissected and unclamped. Limited experience suggests that this new technique provides adequate myocardial protection, while keeping surgery both simple and safe.

Briefly occlusive coronary anastomosis with tissue adhesive.

OBJECTIVE: We assessed the feasibility of a facilitated, briefly occlusive, sutureless coronary anastomosis technique in which side-to-side preglued (octylcyanoacrylate adhesive) bounded walls were opened by a conventional arteriotomy. METHODS: In low-flow (prothrombotic milieu,

Cannulation of a LIMA graft via the right brachial arterial route using a MANI catheter: an alternative approach.

Some different revascularization methods including coronary artery bypass surgery can be performed in the treatment of coronary artery disease. Saphenous vein grafts and/or arterial grafts including left internal mammary artery (LIMA) can be implanted during coronary bypass surgery. It is necessary to perform cannulation of the LIMA, in order to diagnose and treat these patients. In addition to conventional internal mammary artery catheters, several types of catheters can be used for this purpose. In general, LIMA catheterization via the femoral artery has been preferred over other methods. However, the right brachial arterial approach can be mandatory in some rare conditions. In this report, we describe an alternative method to the conventional techniques of the LIMA graft angiography via the right brachial arterial approach using a MANI catheter. According to our knowledge, no data are available using the MANI catheter for this purpose in the current literature.

Hepatocellular carcinoma: involvement of the internal mammary artery.

PURPOSE: To investigate factors related to the development of internal mammary arteries (IMAs) as feeding arteries of hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: In 30 patients with HCC located in ventral hepatic areas directly beneath the diaphragm, bilateral internal mammary arteriography was performed to explore involvement of the IMA with HCC. The number of previous transcatheter arterial embolizations (TAEs), tumor size, time from initial TAE to IMA angiography, inferior phrenic artery (IPA) involvement with tumor, presence of hepatic artery occlusion, and use of other treatments were compared in groups with and without involvement of the IMA. RESULTS: The group with IMA involvement included 10 patients; the group without involvement, 20 patients. TAE had been performed two to 12 times in the group with involvement and zero to six times in the group without involvement (P =.01). Mean tumor sizes in these two groups were 5.1 and 6.0 cm, respectively; hepatic artery occlusion was noted in nine and zero patients (P =.01) in the two groups. The time from initial TAE to IMA angiography ranged from 3 to 53 months (median, 31.5 months) and from zero to 89 months (median, 0 months) (P =.01). IPA involvement was observed in seven and four patients (P =.015). CONCLUSION: These results strongly suggest that, regardless of tumor size, when HCCs are located in the ventral hepatic areas directly beneath the diaphragm, the IMAs serve as feeding arteries in patients with hepatic artery occlusion caused by repeated TAE.