RESUMO
Eight patients with severe systemic pathologies and refractory angina unsuitable for angioplasty were submitted to palliative surgical revascularization without the use of cardiopulmonary bypass and limited to the culprit vessels. Complete relief from angina was achieved in all patients without postoperative mortality and morbidity.
Assuntos
Angina Pectoris/complicações , Angina Pectoris/cirurgia , Ponte de Artéria Coronária/métodos , Idoso , Transtornos Cerebrovasculares/complicações , Feminino , Humanos , Cirrose Hepática/complicações , Pneumopatias Obstrutivas/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Fibrose Pulmonar/complicaçõesRESUMO
We report a case in which an unrevealed high origin of the right coronary artery (almost 4 cm above the left coronary sinus) led to major complications during a routine atrial septal defect closure. We stress that, in absence of preoperative coronary angiography, coronary artery anomalies should always be considered and minimal ascending aorta manipulation and antegrade/ retrograde myocardial protection should be recommended.
Assuntos
Anomalias dos Vasos Coronários/complicações , Comunicação Interatrial/cirurgia , Complicações Intraoperatórias , Adolescente , Aorta/anormalidades , Aorta/cirurgia , Perda Sanguínea Cirúrgica , Angiografia Coronária , Circulação Coronária , Parada Cardíaca Induzida , Humanos , Masculino , Isquemia Miocárdica/etiologia , Cuidados Pré-OperatóriosRESUMO
BACKGROUND: Minimally invasive coronary artery bypass grafting has recently been introduced into cardiac surgery. In this report we discuss the incidence of surgically induced distal target vessel stenosis in patients who undergo the minimally invasive coronary artery bypass grafting procedure, which represents a major drawback of the procedure in our experience. METHODS: Doppler evaluation of mammary artery flow was performed postoperatively in all 55 patients who underwent minimally invasive coronary artery bypass grafting at our institution. Angiography was performed in the first 35 consecutive patients for control purposes and in 2 patients who complained of angina recurrence. RESULTS: In 32 of the first 35 consecutive patients, the anastomosis was found to be functioning normally and the distal left anterior descending artery was normal; in the remaining 3 patients we found mammary artery occlusion, anastomotic stenosis, and stenosis of the anastomosis and the distal left anterior descending artery in 1 patient each. A distal left anterior descending artery stenosis was found in the only 2 patients who underwent late angiography. CONCLUSIONS: Surgically induced distal target vessel stenosis represents a major drawback of minimally invasive coronary artery bypass grafting in our experience. Further improvement in the means of achieving coronary artery occlusion, as well as in anticoagulant and antiplatelet therapy, is mandatory before minimally invasive coronary artery bypass grafting can be confidently accepted into clinical practice.
Assuntos
Ponte de Artéria Coronária/efeitos adversos , Vasos Coronários/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Constrição Patológica , Angiografia Coronária , Ponte de Artéria Coronária/métodos , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-OperatóriasRESUMO
We herein report the case of a patient with idiopathic thrombocytopenic purpura (Werlhof disease) and coronary artery disease undergoing myocardial revascularization. The use of monomeric immunoglobulins, corticosteroids, platelets transfusion, use of a cell saver, normothermic cardiopulmonary bypass, aprotinine and homologous blood transfusion were combined in order to minimize the risk of bleeding complications in the postoperative period.
Assuntos
Doença das Coronárias/complicações , Doença das Coronárias/cirurgia , Revascularização Miocárdica , Hemorragia Pós-Operatória/prevenção & controle , Púrpura Trombocitopênica Idiopática/complicações , Idoso , Ponte Cardiopulmonar , Feminino , Humanos , Contagem de Plaquetas , Período Pós-Operatório , Púrpura Trombocitopênica Idiopática/sangueRESUMO
We report one case in which chronic native competitive flow from an almost normal target coronary artery did not influence IMA graft patency. This patient underwent control postoperative angiography 11 months after surgery and the mammary artery-left anterior descending graft was found to be normofunctioning despite the fact that the coronary artery showed no residual stenosis.