Inadequate internal mammary artery graft as a cause of postoperative ischemia: incidence, diagnosis and management.

Inadequate left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD) was encountered in 10 of 3,076 patients between 1984 and July 1990. The mean number of bypass grafts was 2.9 per patient. All patients with inadequate LIMA grafts were stable preoperatively with normal to moderately reduced left ventricular function. No technical difficulties were encountered during surgery. All patients were weaned off cardiopulmonary bypass with minimal or no inotropic support. Each patient developed myocardial ischemia of the LAD territory and/or circulatory collapse or recurrent ventricular dysrhythmia during the first 24 h postoperatively. Six patients, who were immediately re-operated on and had an additional saphenous graft to the LAD, recovered with no infarction and good functional results. Four patients, who were medically treated, developed myocardial infarction. In cases of refractory circulatory collapse and/or ventricular dysrhythmia, inadequate LIMA flow should be suspected. We recommend urgent re-operation with additional saphenous vein graft to the LAD.

The value of thermography in the early diagnosis of postoperative sternal wound infections.

Peristernal skin temperatures were recorded postoperatively by infrared thermography in 150 patients. Persistent elevation of peristernal skin temperature during the 3rd and 4th post-operative week was found in 5 patients, all of whom developed sternal wound infection. A further group of 18 patients, all suspected to have occult wound infection, showed persistent temperature elevation in 7 patients, 6 of these patients were proven later to have manifest infection and needed treatment. Close thermographic scruting of the incision in patients with suspected but not proven infection appears to be useful in deleting early stages of deep seated infections.

Diffuse dilatation of autogenous saphenous vein grafts used to replace the renal and superior mesenteric arteries. A case report.

Of the many different materials used to replace diseased arteries, autogenous saphenous vein grafts are among the most favored. This view is also explicitly expressed regarding patients who suffer from occlusive arterial disease of the abdominal viscera, particularly the renal vessels. There is, however, recent information which suggests that for reasons unknown saphenous vein grafts in the renal position are likely to be subject to both diffuse and aneurysmatic dilatation, a complication seen only seldom in the femoral and practically never in the coronary position. The purpose of this paper is to present the case of a young woman with fibromuscular stenosis of both her abdominal renal and the mesenteric arteries whose condition was surgically corrected using autogenous vein grafts. Despite the fact that at the time of her surgery her saphenous vein appeared to be both macroscopically and microscopically intact and postoperatively her blood pressure returned to normal, she developed diffuse, aneurysmatic dilatation of all of her vein grafts.

Ascending-distal abdominal aorta bypass for treatment of hypoplastic aortic arch and atypical coarctation in the adult.

Repair of aortic coarctation is usually an easy operation. However, it can be very difficult under certain circumstances. These include operating on an adult or operating when specific anatomical variations, such as hypoplasia of the transverse aortic arch or calcification of the coarctation area, are present. We recommend that in such cases the situation be handled using ascending aorta-lower abdominal aorta bypass grafts rather than conventional resection and anastomosis of the coarctation itself. The cases of 2 patients are presented in whom a hypoplastic aortic arch associated with atypical coarctation was repaired using such a procedure.

Long-term observations on a crimped Dacron aortic bypass graft in the growing child.

Nineteen years of clinical and angiographic observations are presented on a patient with congenital stricture of the upper abdominal aorta who underwent thoracic-to-abdominal aorta bypass grafting using a woven crimped Dacron vascular prosthesis. These observations indicate that if such a prosthesis is properly applied, i.e., attached in a proper angle and is not stretched as it is usually done in the adult, then it will be capable of gradual "lengthening" through the years and thus adapt to the needs of a growing child.