An interesting case of giant fusiform right coronary artery aneurysm

Coronary artery aneurysm is an uncommon cardiovascular disease and a standard surgical approach is still not recognized. A 58‐year‐old man was referred to our department, after being investigated for worsening shortness of breath and tiredness, with a diagnosis of a 70 mm right coronary artery aneurysm. Surgical excision of the aneurysm and single vein graft on the posterior descending artery was performed, with satisfactory results.     

Aortocoronary saphenous vein graft aneurysm in redo coronary artery bypass grafting: Report of a case

(Received for publication on Oct. 14, 1996; accepted on Mar. 4, 1997)     

川崎病并发巨大冠状动脉瘤双源CT表现1例

患者男,22岁,反复心悸6年,伴黑朦2次。4岁时曾高热,持续数日。体检发现心界向左下扩大。实验室检查：血、尿常规,血沉,肝肾功能及心肌损伤标志物均正常。心脏彩超示左冠状动脉起始段内径增宽并瘤样扩张,管壁钙化;左心室扩大,左心室壁节段运动异常,左心室收缩功能受损,射血分数为0.43。双源CT冠脉扫描示左侧冠状动脉主干至前降支近段见管腔梭形膨大,最宽处约16.4 mm,管壁环形硬化斑块形成,     

基于互联网络的延续护理对川崎病并发冠状动脉瘤患儿家庭照顾负担的影响

目的探讨基于互联网络的延续护理对减轻川崎病并发冠状动脉瘤患儿家庭照顾负担的影响。方法选取川崎病并发冠状动脉瘤的连续病例68例,根据使用互联网络平台前后分为对照组33例和干预组35例。对照组使用常规的出院指导,干预组在此基础上采用微信、QQ、手机App等各形式实施延续护理。比较两组在出院后6个月在家庭负担会谈量表(FBS)、川崎病知识问卷得分。结果干预6个月后干预组照顾者的家庭日常活动、家庭娱乐活动、家庭关系、家庭成员躯体健康、心理健康维度评分及家庭负担总分显著低于对照组(P0.05,P0.01);川崎病知识问卷得分显著高于对照组(P0.01)。结论运用多种网络工具下的延续护理可以提高川崎病并发冠状动脉瘤患儿照护者对疾病的掌握度,减轻患儿的家庭负担。     

Atypical Kawasaki disease: A patient with coronary,brain, and internal mammary arteritis

Here we report a rare case of atypical Kawasaki disease (KD) in a patient presenting with systemic arteritis affecting the coronary arteries, brain, and internal mammary arteries (IMAs). A 25‐year‐old man was referred to our institute with angina pectoris. Coronary angiography revealed coronary artery aneurysms and triple‐vessel disease. Three‐dimensional brain computed tomography showed multiple small saccular aneurysms on the vertebral and posterior inferior cerebellar arteries. Off‐pump coronary artery bypass (OPCAB) grafting ??????was performed; however, the bilateral IMAs were tightly adhered and not patent. OPCAB was completed using the bilateral radial and gastroepiploic arteries. This is the first report of KD involving the IMA.     

Challenging surgery of giant right coronary aneurysm associated with coronary sinus fistula

Coronary artery fistula is a rare congenital or acquired anomaly. It involves an abnormal connection between the coronary artery and the cardiac chambers or the large thoracic vessels. In some cases, the feeding coronary artery can become extremely dilated. The treatment includes a transcatheter or a surgical intervention depending on the complexity of the anomaly. We present the surgical treatment of the coronary artery to coronary sinus fistula, which includes the complete exclusion of the giant right coronary artery and followed by triple bypass surgery.     

Giant right coronary artery aneurysm in the setting of the acute coronary syndrome: A case report

Giant right coronary artery (RCA) aneurysm is a rare coronary artery pathology. We describe a 45-year-old gentleman who presented with unstable angina of recent onset. Diagnostic workup including chest computed tomography angiography and left heart catheterization demonstrated three-vessel coronary artery disease with giant proximal RCA aneurysm. In the view of the severity of the coronary artery disease and the risk of rupture associated with the giant RCA aneurysm and the clinical presentation, the patient was successfully treated by coronary artery bypass surgery. During this procedure, the RCA aneurysm was ligated at both inflow and outflow. The patient recovered well and was discharged home.     

Minimally invasive coronary artery bypass grafting surgery in a child with Kawasaki disease

An 8-year-old girl with Kawasaki disease underwent surgical revascularization to the left anterior descending coronary artery on the beating heart via a left anterior short thoracotomy. Angiography 21 months after surgery showed excellent graft patency. This case--the first success in minimally invasive surgical coronary artery revascularization in a child in the world--suggests that minimally invasive methods are a reasonable alternative in coronary artery revascularization in a child with Kawasaki disease whose left anterior descending artery is the only requiring it.     

One-stage thoracic aortic aneurysm treatment and coronary artery bypass grafting

OBJECTIVE: The treatment of thoracic aortic aneurysm accompanied by ischemic heart disease presents a surgical challenge and has up to now shown a high hospital mortality rate. This report discusses the factors contributing to improved results in these cases. METHODS: We conducted a retrospective analysis of the records of 24 consecutive patients who had undergone replacement of thoracic aorta with combined coronary artery bypass grafting (CABG) between May 1991 and October 1998. Fifteen patients received total arch replacement (Arch-with-CABG Group), and the other 9 patients received the Bentall operation (Bentall-with-CABG Group). These results were compared with those patients who had undergone replacement of the thoracic aorta without CABG (Without-CABG Group). RESULTS: In the combined CABG groups, the overall operative mortality rate was 16.7%. In comparison with the Arch-without-CABG Group, there was a significantly longer cardiopulmonary bypass time and longer selective cerebral perfusion time in the Arch-with-CABG Group. However, no significant difference was observed in postoperative complications between the two groups. In addition, there was no significant difference in either actuarial survival or the cardiac-event-free rate at 5 years between the replacement of thoracic aorta with- and without-CABG Groups (83.1% vs. 90.4%, and 78.5% vs. 77.7%, respectively). No reoperation and no late death were observed during the follow-up period (mean 21.3 months). CONCLUSIONS: We concluded that replacement of the thoracic aorta combined with CABG can be carried out safely, and that revascularization for coronary artery disease is useful for preventing any occurrence of cardiac event.     

Surgical resection of the giant right coronary artery aneurysm

A 74‐year‐old man had undergone two‐vessel coronary artery bypass grafting (CABG), 19 years ago, with the left internal mammary artery (LITA) to the left anterior descending artery and the saphenous vein graft (SVG) to the posterior descending artery. In outpatient care, a thoracic aortic aneurysm was suspected by the chest X‐ray. In the computed tomography, appeared the distal arch aortic aneurysm, abdominal aortic aneurysm (AAA), and giant right coronary artery aneurysm (rCAA). The diameter of rCAA was 70 mm and it oppressed the right atrium and ventricle of the heart. The patient was referred to our hospital. After the initial treatment of distal arch aneurysm and AAA, surgical treatment for the rCAA was performed. The rCAA was resected completely and CABG with new SVG was performed without cardiopulmonary bypass. The histopathology of rCAA wall revealed that the etiology was an atherosclerotic change. The postoperative course was good, the oppressed right heart system was released and the hemodynamics of the tricuspid valve showed improvement.     

左心室功能明显减退患者的冠状动脉旁路术

目的 探讨左心室功能明显减退患者的冠状动脉旁路移植术(CABG)的外科治疗效果。方法 回顾分析2000年12月至2002年12月对心肌梗死或长期慢性心肌缺血造成心室功能明显减退的45例冠心病患者进行CABG的相关资料。结果 42例联合应用左乳内动脉与前降支吻合。人均旁路移植3.3(1～5)支,无手术死亡。术后随访2～23个月,LVEF21.3％～65％,平均(42.7±5.9)％,与术前相比提高9％～24％(P<0.05);LVEDD55.2～64.6 mm,平均(54.7±3.8)mm。与术前相比,无明显变化(P>0.05);心绞痛完全消失39例,活动耐力增加。随访期间死亡2例。结论 左心室功能明显减退的冠心病患者,CABG手术成功率和近期效果满意,生活质量明显提高。术前合理选择病例、术中充分的再血管化和良好的围手术期处理是手术成功的关键。     

冠状动脉硬化性心脏病合并左锁骨下动脉严重狭窄非体外循环下同期手术的临床经验

目的探讨非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路治疗冠状动脉硬化性心脏病(冠心病)合并锁骨下动脉重度狭窄的手术方法及效果.方法2003年1月～2004年5月,我院治疗须行冠状动脉旁路移植术同时合并左锁骨下动脉近端重度狭窄3例,术中先行主动脉-锁骨下动脉旁路,左乳内动脉获得满意的流量后,再行非体外循环冠状动脉旁路移植.结果手术时间210～340 min,平均283 min,出血量570～1 630 ml,平均963 ml.游离左乳内动脉后量杯测流量均＜5 ml/min,主动脉-锁骨下动脉旁路后量杯测流量均＞50 ml/min,乳内动脉远端与前降支吻合后流量仪测流量12～27 ml/min,平均20 ml/min.术后临床症状缓解,未发现冠脉-锁骨下动脉窃血综合征.3例随访3～6个月,平均5个月,无心绞痛发作.结论非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路手术是治疗冠心病合并锁骨下动脉重度狭窄简单而有效的方法.     

Coronary artery bypass grafting in an adult case with Kawasaki disease.

Surgical revascularization for coronary artery lesions secondary to Kawasaki disease has been rarely reported in adult patients. We reported an adult case with few coronary risk factors but with multiple coronary artery aneurysms and obstructive lesions presumably secondary to Kawasaki disease who underwent coronary artery bypass grafting (CABG) with multiple arterial grafts. The postoperative course was uneventful. Because coronary artery sequelae of Kawasaki disease can be a cause of ischemic heart disease even in adults, heightened awareness of this possibility is required for young adults with coronary lesions but without coronary risk factors.     

Development of a fistula between an internal mammary artery graft and the pulmonary vasculature following coronary artery bypass grafting: Report of a case

We report herein the rare case of a 56-year-old man who gradually developed congestive cardiac failure 6 months after undergoing coronary artery bypass grafting and was found to have a fistula between the internal mammary artery and the pulmonary artery of the upper lobe diagnosed by selective left internal mammary arteriogram. A second sternotomy was performed and demonstrated dense adhesion between the fissure surrounding the internal mammary artery and the upper lobe, and the fistula was resected. We believe that the patient's increasing cardiac failure was almost certainly caused by coronary steal.     

Percutaneous coronary intervention compared with coronary artery bypass graft in coronary artery disease patients with chronic kidney disease: a systematic review and meta-analysis

Previous reports of percutaneous coronary intervention versus coronary artery bypass graft outcomes in coronary artery disease patients with chronic kidney disease (CKD) were inconsistent. We evaluated the optimal revascularization strategy for CKD patients. We searched Pub Med, EMBASE, and the Cochrane Central Register of Controlled Trials and scanned the references of relevant articles and reviews. All studies that compared relevant clinical outcomes between percutaneous coronary intervention and coronary artery bypass graft in CKD patients were selected. We defined short-term and long-term all-cause mortality as primary outcome, and long-term incidences of myocardial infarction and revascularization as secondary outcomes. A total of 2235 citations were retrieved, and 31 studies involving 99,054 patients, with 55,383 receiving percutaneous coronary intervention and 43,671 receiving coronary artery bypass graft, were included. In subgroup analyses of dialysis patients receiving percutaneous coronary intervention with stents versus coronary artery bypass graft, CKD patients with multivessel coronary disease, and CKD patients receiving drug-eluting stent versus coronary artery bypass graft, the pooled outcomes revealed that percutaneous coronary intervention possessed lower short-term mortality, but higher late revascularization risk. No significant differences in long-term mortality were observed between the two strategies in these subgroup analyses. In conclusion, in some specific clinical circumstances, CKD patients receiving percutaneous coronary intervention possessed lower short-term all-cause mortality, but higher long-term revascularization risk, than coronary artery bypass graft; long-term all-cause mortality was not different between the two strategies.     

Off-pump coronary artery bypass combined with abdominal aortic aneurysm repair in an 88-year-old male

We present the case of an 88-year-old patient who underwent off-pump coronary artery bypass using an aortic connector followed by repair of an abdominal aortic aneurysm to reduce surgical invasiveness. This approach merits consideration for high-risk patients.     

川崎病冠状动脉病变及搭桥手术

目的 探讨川崎病后严重冠状动脉病变及搭桥手术（ＣＡＢＧ）后的近期及远期效果。方法随访发现,６例川崎病后严重冠状动脉病变的病儿均有左冠状动脉前降支（ＬＡＤ）病变,右冠状动脉（ＲＣＡ）病变５例,左冠状动脉回旋支（ＬＣＸ）病变３例,左冠状动脉主干（ＬＭＴ）病变２例,心肌梗死３例。共行１５支ＣＡＢＧ;单支２例,３支３例,４支１例;左胸廓内动脉（ＬＩＴＡ）至ＬＡＤ６例;右胸廓内动脉（ＲＩＴＡ）至ＬＡＤ１例。     

Successful coronary artery bypass grafting for a patient with myelodysplastic syndrome: Report of a case

We report herein the case of a 61-year-old man with myelodysplastic syndrome causing pancytopenia who underwent successful coronary artery bypass grafting (CABG). Preoperatively, his hemoglobin (Hb) value was 10.4 g/dl while receiving transfusions of 1 or 2 units of red blood cells (RBC) every 2 weeks, his white blood cell (WBC) count was 8200/l with injections of 100 g granulocyte colony-stimulating factor (G-SCF) every 5 days, and his platelet count was 4.5×10⁴/l without platelet transfusion. From the time the pancytopenia was diagnosed in his peripheral blood, he had received a total of 104 units of RBC and 472 units of platelets, following which he developed an antiplatelet antibody, not for a platelet-specific antigen, but for an HLA antigen. Thus, HLA-matched platelets were prepared to prevent bleeding caused by thrombocytopenia, and the WBC count was elevated preoperatively by G-CSF injections. Thereafter, CABG was performed on three vessels. The HLA-matched platelets were transfused as the patient was weaned from the extracorporeal circulation. As a result of these preparations, we were able to protect the patient against bleeding and infection.