Pub Date : 2021-01-01DOI: 10.7793/jcad.27.21-00003
Yuki Imamura, Ryosuke Kowatari, Norihiro Kondo, K. Daitoku, Yoshiaki Saito, M. Minakawa, I. Fukuda
Papillary muscle rupture is a rare but devastating complication following acute myocardial infarction (AMI). Although preventing the development of cardiogenic shock is important in such cases, the optimal multidisciplinary treatment approach is still not established. Here, we report two cases of papillary muscle rupture following AMI with different outcomes due to differences in the timing of coronary artery revascularization and mechanical circulatory support. Case reports
{"title":"Different Outcomes in Two Cases of Papillary Muscle Rupture with Different Timings of Coronary Revascularization, Mechanical Circulatory Support, and Surgery","authors":"Yuki Imamura, Ryosuke Kowatari, Norihiro Kondo, K. Daitoku, Yoshiaki Saito, M. Minakawa, I. Fukuda","doi":"10.7793/jcad.27.21-00003","DOIUrl":"https://doi.org/10.7793/jcad.27.21-00003","url":null,"abstract":"Papillary muscle rupture is a rare but devastating complication following acute myocardial infarction (AMI). Although preventing the development of cardiogenic shock is important in such cases, the optimal multidisciplinary treatment approach is still not established. Here, we report two cases of papillary muscle rupture following AMI with different outcomes due to differences in the timing of coronary artery revascularization and mechanical circulatory support. Case reports","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71175989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.7793/jcad.27.21-00016
S. Sueda, Tomoki Sakaue
In 1986, intracoronary acetylcholine (ACh) testing was first reported . Since then, intracoronary ACh test has become popular as a spasm provocation test as well as ergonovine (ER) test in the world -. Intracoronary injection of ACh has a short half life of this agent and so intracoronary ACh testing considered to be a relatively safe method. However, we experienced some complications such as ventricular fi brillation or tachycardia necessary for electric cardioversion, severe hypotension or left main trunk equivalent spasm during the ACh tests. Furthermore, we also experienced transient paroxysmal atrial fi brillation (PAF) in a sixth of patients who underwent ACh testing based on the Japanese Circulation Society guidelines 7, . ACh-inducible PAF is one of a mechanism of a vagally-mediated PAF . There are no reports concerning the reproducibility of ACh-inducible PAF in the same patients. In this article, we retrospectively investigated the reproducibility of ACh-inducible PAF in the same patients.
{"title":"Reproducibility of Occurrence of Paroxysmal Atrial Fibrillation in Patients Who Had Acetylcholine Testing","authors":"S. Sueda, Tomoki Sakaue","doi":"10.7793/jcad.27.21-00016","DOIUrl":"https://doi.org/10.7793/jcad.27.21-00016","url":null,"abstract":"In 1986, intracoronary acetylcholine (ACh) testing was first reported . Since then, intracoronary ACh test has become popular as a spasm provocation test as well as ergonovine (ER) test in the world -. Intracoronary injection of ACh has a short half life of this agent and so intracoronary ACh testing considered to be a relatively safe method. However, we experienced some complications such as ventricular fi brillation or tachycardia necessary for electric cardioversion, severe hypotension or left main trunk equivalent spasm during the ACh tests. Furthermore, we also experienced transient paroxysmal atrial fi brillation (PAF) in a sixth of patients who underwent ACh testing based on the Japanese Circulation Society guidelines 7, . ACh-inducible PAF is one of a mechanism of a vagally-mediated PAF . There are no reports concerning the reproducibility of ACh-inducible PAF in the same patients. In this article, we retrospectively investigated the reproducibility of ACh-inducible PAF in the same patients.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71176456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kaito Abe, Takemi Kusano, R. Nakajima, Koki Sogame, H. Fukui, Moto Shimada, H. Doi, Goro Endo, Kaori Kanbara, T. Ishigami, K. Tamura, J. Okuda
coronary Kommerell’s diverticulum is a very rare congenital aortic arch anomaly with an estimated incidence of 0.04-0.1%. Few studies have reported on acute ST-segment elevation myocardial infarction in patients with Kommerell’s diverticulum on the right-sided aortic arch. The anatomical anomaly makes coronary artery catheterization difficult. If such a case is suspected during the patient examination before coronary artery revascularization, the appropriate arterial approach site should be carefully considered for revascularization as early as possible.
{"title":"Acute ST-segment Elevation Myocardial Infarction in Kommerell's Diverticulum with a Right-sided Aortic Arch","authors":"Kaito Abe, Takemi Kusano, R. Nakajima, Koki Sogame, H. Fukui, Moto Shimada, H. Doi, Goro Endo, Kaori Kanbara, T. Ishigami, K. Tamura, J. Okuda","doi":"10.7793/JCAD.20-00031","DOIUrl":"https://doi.org/10.7793/JCAD.20-00031","url":null,"abstract":"coronary Kommerell’s diverticulum is a very rare congenital aortic arch anomaly with an estimated incidence of 0.04-0.1%. Few studies have reported on acute ST-segment elevation myocardial infarction in patients with Kommerell’s diverticulum on the right-sided aortic arch. The anatomical anomaly makes coronary artery catheterization difficult. If such a case is suspected during the patient examination before coronary artery revascularization, the appropriate arterial approach site should be carefully considered for revascularization as early as possible.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71173496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
5.0 with maximum fl ow of 6 L/min), and Impella RP (Right Percutaneous - designed to support the right ventri-cle). Impella 5.5 is expected to be available in Japan soon. Historically, intra-aortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS) have been widely used for patients with refractory CS. However, multiple clinical studies show that IABP alone may not improve prognosis of refractory CS 10, 11) . Some of those refractory CS patients may benefi t from PCPS in terms of survival 12) but robust data to validate the strategy is still lacking. The Impella device is hence expected to improve outcomes of patients with drug-resistant acute heart failure including cardiogenic shock as a new therapy option 13) . In Japan, the fi rst implant was done in October 2017 at Osaka University, and since then 1,326 patients have been implanted and enrolled in the Japanese Registry for Percutaneous Ventricular Assist Devices (J-PVAD registry), an investigator-led, pro-Review We report the outcome of patients supported with the Impella device at our institution. Similar to the interim analysis of J-PVAD registry presented at the 84th Annual Scientific Meeting of the Japanese Circulation Society, we observed a worse outcome in patients with AMI cardiogenic shock who received late Impella support. It is also important to highlight that only one patient of this cohort received Impella support before reperfusion at our institute. A door to unloading strategy as opposed to one emphasizing door to balloon combined with earlier initiation of Impella support seems promising 1) and it the creation of a system that embraces door to unloading which is both our institute’s challenge and opportunity to improve outcomes.
{"title":"Impella®, Percutaneous Left Ventricular Assist Device for Cardiogenic Shock","authors":"M. Iida, T. Shimokawa","doi":"10.7793/JCAD.27.001","DOIUrl":"https://doi.org/10.7793/JCAD.27.001","url":null,"abstract":"5.0 with maximum fl ow of 6 L/min), and Impella RP (Right Percutaneous - designed to support the right ventri-cle). Impella 5.5 is expected to be available in Japan soon. Historically, intra-aortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS) have been widely used for patients with refractory CS. However, multiple clinical studies show that IABP alone may not improve prognosis of refractory CS 10, 11) . Some of those refractory CS patients may benefi t from PCPS in terms of survival 12) but robust data to validate the strategy is still lacking. The Impella device is hence expected to improve outcomes of patients with drug-resistant acute heart failure including cardiogenic shock as a new therapy option 13) . In Japan, the fi rst implant was done in October 2017 at Osaka University, and since then 1,326 patients have been implanted and enrolled in the Japanese Registry for Percutaneous Ventricular Assist Devices (J-PVAD registry), an investigator-led, pro-Review We report the outcome of patients supported with the Impella device at our institution. Similar to the interim analysis of J-PVAD registry presented at the 84th Annual Scientific Meeting of the Japanese Circulation Society, we observed a worse outcome in patients with AMI cardiogenic shock who received late Impella support. It is also important to highlight that only one patient of this cohort received Impella support before reperfusion at our institute. A door to unloading strategy as opposed to one emphasizing door to balloon combined with earlier initiation of Impella support seems promising 1) and it the creation of a system that embraces door to unloading which is both our institute’s challenge and opportunity to improve outcomes.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71175092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Japanese physicians have made major contributions in this fi eld of coronary epicardial spasm 13, 14) . Compared with Caucasian variant angina, Japanese variant angina affect fewer female patients and exhibits less organic stenosis, less poor left ventricular function, less prior myocardial infarction, and good prognosis as shown in Table 1 13 - 18) . Under the optimal medications, Japanese variant angina had favorable clinical outcomes, whereas Caucasian variant angina did not have a benign prognosis in the clinic. The incidence of death without organic stenosis in Japanese variant angina is higher than that in Caucasian variant angina. We rarely experi-Review Racial differences regarding coronary vasomotion disorders between Caucasian and Japanese populations are controversial. In the past, coronary epicardial spasm was more often recognized in Japanese people than in Caucasian populations. In contrast, coronary microvascular dysfunction is typically observed in Caucasian patients. Japanese cardiologists perform spasm provocation testing actively in patients with unobstructive coronary artery disease, whereas Caucasian cardiologists except for those in some special institutions may skip coronary reactivity testing in the cardiac catheterization laboratory if they encounter patients with unobstructive coronary artery disease. In this review, we present the racial and ethnic disparities in the incidence and clinical characteristics between Caucasian and Japanese populations with coronary vasomotion disorders.
{"title":"Racial Differences in Patients with Coronary Vasomotion Disorders","authors":"S. Sueda, Tomoki Sakaue","doi":"10.7793/JCAD.27.002","DOIUrl":"https://doi.org/10.7793/JCAD.27.002","url":null,"abstract":"Japanese physicians have made major contributions in this fi eld of coronary epicardial spasm 13, 14) . Compared with Caucasian variant angina, Japanese variant angina affect fewer female patients and exhibits less organic stenosis, less poor left ventricular function, less prior myocardial infarction, and good prognosis as shown in Table 1 13 - 18) . Under the optimal medications, Japanese variant angina had favorable clinical outcomes, whereas Caucasian variant angina did not have a benign prognosis in the clinic. The incidence of death without organic stenosis in Japanese variant angina is higher than that in Caucasian variant angina. We rarely experi-Review Racial differences regarding coronary vasomotion disorders between Caucasian and Japanese populations are controversial. In the past, coronary epicardial spasm was more often recognized in Japanese people than in Caucasian populations. In contrast, coronary microvascular dysfunction is typically observed in Caucasian patients. Japanese cardiologists perform spasm provocation testing actively in patients with unobstructive coronary artery disease, whereas Caucasian cardiologists except for those in some special institutions may skip coronary reactivity testing in the cardiac catheterization laboratory if they encounter patients with unobstructive coronary artery disease. In this review, we present the racial and ethnic disparities in the incidence and clinical characteristics between Caucasian and Japanese populations with coronary vasomotion disorders.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71175152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ISCHEMIA (Initial Invasive or Conservative Strategy for Stable Coronary artery disease) trial was a large, international, multi center, prospective, randomized controlled clinical trial comparing initial invasive plus optimal medical therapy (OMT) strategy versus conservative management plus OMT strategy in stable coronary artery disease patients with moderate to severe ischemia. It is still too early to describe the overall impact of ISCHEMIA trial partly because the result is still in the process of slowly being digested in the cardiology and general communities, but also because COVID-19 pandemic has greatly altered recent cardiology practices in the US and worldwide. However, one thing is very likely. Based on the result of this trial, cardiologists will be asked more often to be cautious about indications for revascularization. A proof of ischemia alone cannot be justified for initial invasive strategy in a stable coronary artery disease patients who are optimally medically managed and asymptomatic or minimally symptomatic. In the early days of angioplasties, “Oculo-stenotic reflex” was frowned upon as a too premature attitude of angioplasty treatment for an anatomically significant coronary stenosis but otherwise unknown hemodynamic or clinical importance. After the ISCHEMIA trial, cardiologists may be asked to shy away from “Ischemia-invasive reflex” in the appropriate context in stable coronary artery disease patients who are optimally medically treated and asymptomatic or minimally symptomatic. According to the result of this trial, proof of significant ischemia is not a “ Carte Blanche ” for early invasive management strategy. On the other hand, this trial did show durable improvement of angina symptoms in the invasive arm compared to conservative arm, thus, as long as the goal of the management is clearly stated to reduce angina and to improve quality of life, early invasive strategy for stable coronary artery disease patients is justifiable in the post ISCHEMIA era. angiogram performed before randomization to exclude unpro-tected left main disease and non-obstructive coronary artery disease. Severe left ventricular systolic dysfunction with ejection fraction <35%, chronic kidney disease patients with GFR below 30 ml/min/1.73 m 2 , recent acute coronary syndrome patients, de-compensated heat failure, and unstable angina patients were also excluded.
缺血(Initial Invasive or Conservative Strategy for Stable冠心病)试验是一项大型、国际、多中心、前瞻性、随机对照临床试验，比较初始有创+最佳药物治疗(OMT)策略与保守治疗+ OMT策略对中度至重度缺血的稳定期冠心病患者的疗效。现在描述缺血试验的总体影响还为时过早，部分原因是结果仍处于心脏病学和普通社区缓慢消化的过程中，但也因为COVID-19大流行极大地改变了美国和全世界最近的心脏病学实践。然而，有一件事是很有可能的。根据这项试验的结果，心脏病专家将被要求更经常地对血运重建术的适应症保持谨慎。对于经最佳医学治疗且无症状或症状轻微的稳定冠状动脉疾病患者，仅凭缺血的证据不能作为初始侵入策略的理由。在血管成形术的早期，“眼狭窄反射”被认为是一种过早的血管成形术治疗态度，用于解剖上重要的冠状动脉狭窄，但其他方面血流动力学或临床重要性未知。在缺血试验后，心脏病学家可能会被要求在适当的情况下避免“缺血侵袭性反射”，这些患者是稳定的冠状动脉疾病患者，他们经过了最佳的药物治疗，无症状或症状最小。根据这项试验的结果，证明明显缺血并不是早期有创治疗策略的“全权委托”。另一方面，与保守组相比，该试验确实显示出有创组心绞痛症状的持续改善，因此，只要治疗的目标明确为减少心绞痛和提高生活质量，在缺血后时代，对稳定型冠状动脉疾病患者采取早期有创策略是合理的。随机分组前进行血管造影以排除无保护的左主干疾病和非阻塞性冠状动脉疾病。排除了射血分数<35%的严重左室收缩功能不全、GFR低于30 ml/min/1.73 m2的慢性肾病患者、近期急性冠状动脉综合征患者、失代偿性热衰竭患者和不稳定型心绞痛患者。
{"title":"Impact of ISCHEMIA Trial on Clinical Practice","authors":"H. Yamasaki","doi":"10.7793/jcad.26.001","DOIUrl":"https://doi.org/10.7793/jcad.26.001","url":null,"abstract":"ISCHEMIA (Initial Invasive or Conservative Strategy for Stable Coronary artery disease) trial was a large, international, multi center, prospective, randomized controlled clinical trial comparing initial invasive plus optimal medical therapy (OMT) strategy versus conservative management plus OMT strategy in stable coronary artery disease patients with moderate to severe ischemia. It is still too early to describe the overall impact of ISCHEMIA trial partly because the result is still in the process of slowly being digested in the cardiology and general communities, but also because COVID-19 pandemic has greatly altered recent cardiology practices in the US and worldwide. However, one thing is very likely. Based on the result of this trial, cardiologists will be asked more often to be cautious about indications for revascularization. A proof of ischemia alone cannot be justified for initial invasive strategy in a stable coronary artery disease patients who are optimally medically managed and asymptomatic or minimally symptomatic. In the early days of angioplasties, “Oculo-stenotic reflex” was frowned upon as a too premature attitude of angioplasty treatment for an anatomically significant coronary stenosis but otherwise unknown hemodynamic or clinical importance. After the ISCHEMIA trial, cardiologists may be asked to shy away from “Ischemia-invasive reflex” in the appropriate context in stable coronary artery disease patients who are optimally medically treated and asymptomatic or minimally symptomatic. According to the result of this trial, proof of significant ischemia is not a “ Carte Blanche ” for early invasive management strategy. On the other hand, this trial did show durable improvement of angina symptoms in the invasive arm compared to conservative arm, thus, as long as the goal of the management is clearly stated to reduce angina and to improve quality of life, early invasive strategy for stable coronary artery disease patients is justifiable in the post ISCHEMIA era. angiogram performed before randomization to exclude unpro-tected left main disease and non-obstructive coronary artery disease. Severe left ventricular systolic dysfunction with ejection fraction <35%, chronic kidney disease patients with GFR below 30 ml/min/1.73 m 2 , recent acute coronary syndrome patients, de-compensated heat failure, and unstable angina patients were also excluded.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.20-00018
K. Vora, U. Surana, A. Ranjan
{"title":"Anomalous Right Coronary Artery Origin","authors":"K. Vora, U. Surana, A. Ranjan","doi":"10.7793/jcad.26.20-00018","DOIUrl":"https://doi.org/10.7793/jcad.26.20-00018","url":null,"abstract":"","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.20-00007
M. Hosono, H. Yasumoto, Shintaro Kuwauchi, N. Taniguchi, Tomohiko Uetsuki, T. Okada, S. Kanemoto, N. Zempo, N. Minato, K. Kawazoe
In coronary artery bypass grafting (CABG), arterial grafts provide superior results compared with saphenous vein grafts (SVGs). Among arterial grafts, using bilateral internal thoracic artery grafts is associated with good survival benefits and graft patency-. However, in-situ right internal thoracic artery grafting (RITA) is used for limited coronary arteries because of the insufficient length. In contrast, free RITA grafts can be used for sequential multiple grafting and grafting to the distal branches. Therefore, in multi-vessels bypass grafting, free RITA grafting can be more feasible than in-situ RITA. In addition, we avoid retrosternal in-situ RITA crossover routing due to concerns about the potential risks of damage to the RITA in re-sternotomy or deep sternal wound infection. For these reasons, the free RITA is used as the second graft alternative in our institute, except in older patients. When using free RITAs, there are several alternatives as a proximal anastomotic site, such as the aorta, a left internal thoracic artery graft (LITA), a radial artery graft, or a SVG-. Among these anastomotic sites, SVGs are technically the most simple, and we anastomose a free RITA to the hood of the SVG close to the suture line of its aortic anastomosis. In this technique, there is concern regarding a flow-steal phenomenon between the two grafts as in composite Y-grafting with the LITA . However, correlations in the graft flow between a free RITA and an SVG have not been clarified. We report the operative results following CABG using free RITAs in our institute and the results of a flow measurement study of proximally anastomosing a free RITA to the hood of a SVG at its aortic anastomosis.
{"title":"Flowmetric Assessment of the Free Right Internal Thoracic Artery Anastomosed Proximally to a Saphenous Vein Graft to Revascularize the Left Coronary Artery System","authors":"M. Hosono, H. Yasumoto, Shintaro Kuwauchi, N. Taniguchi, Tomohiko Uetsuki, T. Okada, S. Kanemoto, N. Zempo, N. Minato, K. Kawazoe","doi":"10.7793/jcad.26.20-00007","DOIUrl":"https://doi.org/10.7793/jcad.26.20-00007","url":null,"abstract":"In coronary artery bypass grafting (CABG), arterial grafts provide superior results compared with saphenous vein grafts (SVGs). Among arterial grafts, using bilateral internal thoracic artery grafts is associated with good survival benefits and graft patency-. However, in-situ right internal thoracic artery grafting (RITA) is used for limited coronary arteries because of the insufficient length. In contrast, free RITA grafts can be used for sequential multiple grafting and grafting to the distal branches. Therefore, in multi-vessels bypass grafting, free RITA grafting can be more feasible than in-situ RITA. In addition, we avoid retrosternal in-situ RITA crossover routing due to concerns about the potential risks of damage to the RITA in re-sternotomy or deep sternal wound infection. For these reasons, the free RITA is used as the second graft alternative in our institute, except in older patients. When using free RITAs, there are several alternatives as a proximal anastomotic site, such as the aorta, a left internal thoracic artery graft (LITA), a radial artery graft, or a SVG-. Among these anastomotic sites, SVGs are technically the most simple, and we anastomose a free RITA to the hood of the SVG close to the suture line of its aortic anastomosis. In this technique, there is concern regarding a flow-steal phenomenon between the two grafts as in composite Y-grafting with the LITA . However, correlations in the graft flow between a free RITA and an SVG have not been clarified. We report the operative results following CABG using free RITAs in our institute and the results of a flow measurement study of proximally anastomosing a free RITA to the hood of a SVG at its aortic anastomosis.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.19-00014
S. Kosugi, M. Awata, Y. Ueda, H. Abe, T. Mishima, K. Shinouchi, T. Ozaki, Kotaro Takayasu, Y. Iida, T. Ohashi, C. Toriyama, Masayuki Nakamura, Yasuhiro Ueda, Shun-ichi Sasaki, M. Matsumura, Takashi Iehara, M. Date, M. Uematsu, Y. Koretsune
BioFreedom is drug-coated stent (DCS) which has polymer-free design. Although it is expected to achieve earlier arterial repair after DCS implantation as compared to the other drug-eluting stents, angioscopic findings have not been described to date. This is the first report of serial angioscopic observation of DCS implanted at acute coronary syndrome (ACS) culprit. A 75-year-old man was admitted with ACS. Coronary angiogram revealed severe stenosis and thrombus in a large diagonal artery. DCS (BioFreedom 3.0 × 18 mm) was implanted at the culprit of ACS. Coronary angioscopy was performed immediately, one and a half months, and 1 year after stent implantation to evaluate arterial repair after the implantation. Coronary angioscopy showed that uncovered stent struts on the white vessel wall and culprit ruptured yellow plaque with stent struts penetration were observed immediately after stent implantation. At one and a half months, majority of stent struts were not yet covered by neointima and the ruptured yellow plaque remained unhealed with thrombus adhesion. At one year under continued dual antiplatelet therapy, ruptured yellow plaque was covered by white neointima and no thrombus was observed. Although DCS implanted at ACS culprit was well covered by white neointima without thrombus at 1 year, arterial repair at one and half months after DCS implantation did not appear good yet.
{"title":"Serial Angioscopic Evaluation of Arterial Repair After the Implantation of Drug-Coated Stent at the Culprit of Acute Coronary Syndrome","authors":"S. Kosugi, M. Awata, Y. Ueda, H. Abe, T. Mishima, K. Shinouchi, T. Ozaki, Kotaro Takayasu, Y. Iida, T. Ohashi, C. Toriyama, Masayuki Nakamura, Yasuhiro Ueda, Shun-ichi Sasaki, M. Matsumura, Takashi Iehara, M. Date, M. Uematsu, Y. Koretsune","doi":"10.7793/jcad.26.19-00014","DOIUrl":"https://doi.org/10.7793/jcad.26.19-00014","url":null,"abstract":"BioFreedom is drug-coated stent (DCS) which has polymer-free design. Although it is expected to achieve earlier arterial repair after DCS implantation as compared to the other drug-eluting stents, angioscopic findings have not been described to date. This is the first report of serial angioscopic observation of DCS implanted at acute coronary syndrome (ACS) culprit. A 75-year-old man was admitted with ACS. Coronary angiogram revealed severe stenosis and thrombus in a large diagonal artery. DCS (BioFreedom 3.0 × 18 mm) was implanted at the culprit of ACS. Coronary angioscopy was performed immediately, one and a half months, and 1 year after stent implantation to evaluate arterial repair after the implantation. Coronary angioscopy showed that uncovered stent struts on the white vessel wall and culprit ruptured yellow plaque with stent struts penetration were observed immediately after stent implantation. At one and a half months, majority of stent struts were not yet covered by neointima and the ruptured yellow plaque remained unhealed with thrombus adhesion. At one year under continued dual antiplatelet therapy, ruptured yellow plaque was covered by white neointima and no thrombus was observed. Although DCS implanted at ACS culprit was well covered by white neointima without thrombus at 1 year, arterial repair at one and half months after DCS implantation did not appear good yet.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.20-00001
K. Miyajima, Y. Date, K. Hatada, T. Ishikawa, Masao Takahashi
rather than catheter intervention. And sur gical AAA repair was thought to be risky due to his respiratory dysfunction. A 75 years old male patient with severe kyphoscoliosis suffered from both coronary artery disease (CAD) and abdominal aortic aneurysm (AAA). Coronary angiography and multi-detector computed tomography showed severe stenosis of left anterior descending (LAD) artery. Difficulty of the catheterization into left coronary due to severe aortic meander suggested difficulty of catheter intervention. Computed tomography revealed an infrarenal AAA measuring 51 mm. The patient also had respiratory dysfunction. Two-staged surgery for both CAD and AAA were considered higher risk for the patient, simultaneous surgery of minimal invasive direct coronary artery bypass grafting (MIDCAB) and endovascular aneurysm repair (EVAR) was selected. The operation was performed safely, and postoperative course was uneventful. Although the candidate of the simultaneous operation was limited, this procedure provided a new alternative for the treatment of combined case of CAD and AAA.
{"title":"A Case of Simultaneous Surgery of Minimal Invasive Direct Coronary Artery Bypass Grafting and Endovascular Aneurysm Repair in a Patient with Severe Kyphoscoliosis","authors":"K. Miyajima, Y. Date, K. Hatada, T. Ishikawa, Masao Takahashi","doi":"10.7793/jcad.26.20-00001","DOIUrl":"https://doi.org/10.7793/jcad.26.20-00001","url":null,"abstract":"rather than catheter intervention. And sur gical AAA repair was thought to be risky due to his respiratory dysfunction. A 75 years old male patient with severe kyphoscoliosis suffered from both coronary artery disease (CAD) and abdominal aortic aneurysm (AAA). Coronary angiography and multi-detector computed tomography showed severe stenosis of left anterior descending (LAD) artery. Difficulty of the catheterization into left coronary due to severe aortic meander suggested difficulty of catheter intervention. Computed tomography revealed an infrarenal AAA measuring 51 mm. The patient also had respiratory dysfunction. Two-staged surgery for both CAD and AAA were considered higher risk for the patient, simultaneous surgery of minimal invasive direct coronary artery bypass grafting (MIDCAB) and endovascular aneurysm repair (EVAR) was selected. The operation was performed safely, and postoperative course was uneventful. Although the candidate of the simultaneous operation was limited, this procedure provided a new alternative for the treatment of combined case of CAD and AAA.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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