Yoshinori Tanimoto

Multiple free (aorta-coronary) gastroepiploic artery grafting

The use of in situ gastroepiploic artery grafts has been reported recently. In the present case, the in situ gastroepiploic artery was too short to graft both the diagonal and the obtuse marginal branches of the coronary arteries in a patient with diffuse coronary artery disease. The free (aorta-coronary) gastroepiploic artery graft was anastomosed to both arteries to form a Y graft.

Angiographic Follow-up of Internal Thoracic Artery for Free Bypass Grafting

BACKGROUND The use of free internal thoracic artery (ITA) grafts in patients with smaller body surface areas has been questioned because of technical difficulties and inadequate graft flow. METHODS To evaluate postoperative changes in the diameter of free ITA grafts, we performed coronary angiography immediately after coronary artery bypass grafting and then again at a mean of 42 +/- 6 months later. In 20 consecutively treated patients, 21 free ITAs were used as bypass conduits. Two ITA grafts that were patent at the time of the first angiography had closed at the second angiography. Postoperative changes in ITA graft diameter were measured in the 19 patent ITA grafts. RESULTS At the first angiography, the mean diameters of the proximal, middle, and distal ITA grafts were 2.28 +/- 0.45 mm, 2.34 +/- 0.39 mm, and 2.12 +/- 0.38 mm, respectively. At the second angiography, the mean diameters of the proximal, middle, and distal ITA grafts were 2.85 +/- 0.50 mm, 2.89 +/- 0.53 mm, and 2.72 +/- 0.53 mm, respectively. All segments of the ITA grafts had dilated significantly between the first and second angiographic evaluations (p < 0.01). The percentage change in graft diameter was greater when the initial ITA diameter was less than 2.3 mm (32.0% +/- 28.0%) than when it was 2.3 mm or more (18.8% +/- 11.3%) (p < 0.05). CONCLUSIONS The postoperative increase in free ITA graft diameter depends on coronary blood flow requirements.

Unroofed coronary sinus demonstrated by two-dimensional echocardiography

Fig. 2. Left panel, Two-dimensional echocardiogram in parasternal, long-axis view demonstrates a mass (T) in the left atrium (LA). Right panel, The left atrium is shown at necropsy with thrombus (T), measuring 3 cm in length and 1 cm in width, attached to the interatrial septum. AV = aortic valve; FO = foramen ovale; LVFW = left ventricular free wall; MV = anterior leaflet of mitral valve; VS = ventricular septum.

Left ventricular motion after bypass operation for coronary artery disease with collaterals

Left ventricular ejection changes obtained from left ventricle roentgenograms were analyzed before and after coronary artery bypass grafting in 22 consecutive patients with chronic obstructive left anterior descending coronary artery disease receiving collaterals before surgical revascularization. The collateral vessels all disappeared after surgical revascularization. After operation, ejection changes of anterobasal, anterolateral and apical walls supplied by the left anterior descending coronary artery improved from 43.6% +/- 9.7% to 48.5% +/- 8.6% (p < 0.05), from 35.2% +/- 10.9% to 39.4% +/- 9.5% (p < 0.05), and from 46.0% +/- 10.6% to 50.0% +/- 8.7% (p < 0.05), respectively. The improvement in left ventricular wall motion did not appear to be related to the extent of preoperative collateralization. Thus, left ventricular wall motion was impaired in the area supplied by collaterals and was improved by myocardial revascularization. These results suggest that coronary blood flow, even through well-developed collaterals, may not be sufficient, which may produce chronic active ischemia and impaired left ventricular wall motion.

False aneurysm formation after ventricular rupture associated with reinfarction following successful thrombolysis.

SummaryA 69-year-old woman underwent successful thrombolysis for total occlusion in the right coronary artery using urokinase. One week later, the patient developed reinfarction in the area supplied by the right coronary artery, followed by ventricular rupture. She was resuscitated with drainage of the pericardial effusion. Cardiac catheterization confirmed that the site of the right coronary artery reocclusion was identical to that in the acute phase. A false aneurysm developed over the true aneurysm located in the inferior portion of the left ventricle as demonstrated by a ventriculogram at the convalescent stage and at surgery. The orifice of the false aneurysm has closed by suture.

Release of intracoronary thrombus during coronary arteriography in a patient with unstable angina.

SummaryA case of release of an intracoronary thrombus in a patient with unstable angina is presented. The thrombus was observed in the right coronary artery just distal to the severe stenosis and was released during coronary arteriography.