[Surgical correction of the Bland-White-Garland syndrome with anomalous origin of right coronary artery - a case report]. / Korekcja chirurgiczna zespolu Blanda-White'a-Garlanda z nieprawidlowym odejsciem prawej tetnicy wiencowej - opis przypadku.

The main cause of the Bland-White-Garland (BWG) syndrome is usually an anomalous origin of the left coronary artery, however, the right coronary artery can be affected as well. We report on the surgical treatment of an adult type BWG syndrome in a 59-year-old male patient. The reason for angiography was anginal pain which occurred 7 years prior to the operation. At that time patient did not agree to undergo surgery, however, symptom aggravation brought him to the hospital again. Because of the vessel anatomy the operator decided to implant a vein graft.

Left main disease management strategy: indications and revascularization methods in particular groups of subjects.

Surgical revascularization with coronary artery by-pass grafting is still recommended in vast majority of patients with unprotected left main disease. The aim of the paper was to analyze optimal treatment of left main disease in selected groups of patients, on the basis of current guidelines and information gained from literature data. We focused on data in relation to treatment of elderly patients, diabetics and those hemodynamically unstable. Additionally we discussed the issue of anti-platelet therapy and informed consent. As far as efficacy of treatment is concerned, not only method of revascularization but also general condition of the patient, the factors influencing peri-operative risk and optimal pharmacotherapy should be taken into account. Therefore establishment of the heart team is crucial when choosing the most suitable method of invasive treatment of left main disease.

A single dose of aprotinin prevents platelet hyporeactivity after coronary artery bypass graft surgery.

INTRODUCTION: Bleeding after coronary artery bypass graft (CABG) surgery is associated with a significant increase in mortality. Even though aprotinin significantly reduces bleeding in patients undergoing cardiac surgery, its use has been recently substantially limited because of serious cardiovascular complications. The exact mechanism of its action, particularly its effect on platelet function, remains unclear. OBJECTIVES: The aim of the study was to assess the effect of aprotinin on platelet function in patients undergoing CABG. PATIENTS AND METHODS: In a randomized placebo-controlled double-blind study, we investigated the effect of a single dose of aprotinin on platelet function in 24 patients who underwent CABG between 2005 and 2006. Before surgery and in the postoperative period, we measured platelet activation markers (P-selectin and activated form of glycoprotein IIb/IIIa) at baseline and following in vitro platelet activation with adenosine diphosphate (ADP) or protease-activated receptor 1 (PAR-1) agonist--thrombin receptor activator for peptide 6 (TRAP-6). Perioperative bleeding and urinary metabolites of thromboxane A2 were also determined. RESULTS: Aprotinin reduced perioperative bleeding by 26% (P <0.01) and prevented a decrease in platelet sensitivity to ADP immediately after CABG. In vitro platelet reactivity to TRAP-6 remained unchanged. Aprotinin did not affect blood platelet count or urinary thromboxane A2 metabolite excretion after CABG. CONCLUSIONS: Our results indicate that aprotinin may reduce perioperative bleeding by its interference with ADP pathway of platelet activation, thereby preventing postoperative hyporeactivity of platelets to ADP. Platelet reactivity to PAR-1 receptor agonist was not affected by aprotinin.