Right coronary artery originating from left anterior descending artery: a case report

Right Coronary Artery (RCA) originating from left anterior descending artery is a very rare congenital coronary artery anomaly. A 66-year-old man presented with hypertension and complaints of exertional chest pain. The angiography was performed. Aortic root angiography showed no coronary ostium orginating from the right sinus of valsalva. Right coronary artery was vizualized as anomalously originating from the midportion of left anterior descending artery. Severe stenosis were seen in ostium of anomalous right coronary artery, in midportion of left anterior descending and in midportion of circumflex artery. The patient was referred for coronary artery bypass grafting. The patient underwent coronary artery bypass surgery for three vessels. He was discharged home on postoperative day 7 without any complication. His echocardiogram on follow-up visit revealed good biventricular function

Pharmacologic prophylaxis for atrial fibrillation following cardiac surgery: a systematic review

Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery. Its incidence varies depending on type of surgery. Postoperative AF may cause hemodynamic deterioration, predispose to stroke and increase mortality. Effective treatment for prophylaxis of postoperative AF is vital as reduces hospitalization and overall morbidity. Beta - blockers, have been proved to prevent effectively atrial fibrillation following cardiac surgery and should be routinely used if there are no contraindications. Sotalol may be more effective than standard b-blockers for the prevention of AF without causing an excess of side effects. Amiodarone is useful when beta-blocker therapy is not possible or as additional prophylaxis in high risk patients. Other agents such as magnesium, calcium channels blocker or non-antiarrhythmic drugs as glycose-insulin - potassium, non-steroidal anti-inflammatory drugs, corticosteroids, N-acetylcysteine and statins have been studied as alternative treatment for postoperative AF prophylaxis

A rare case of epicardial cyst

Objective: We report a recent case of epicardial cyst with constrictive pericarditis. Case report: A male patient aged 20 years presented with the complaint of swelling in both legs for one year. Magnetic resonance imaging of the heart revealed a cystic mass inside the pericardium adjacent to the right ventricle. The patient was operated on by cardiovascular surgeons, with the diagnosis of constrictive pericarditis, and a pericardiectomy was carried out. Discussion: Cardiac cysts originating from the epicardium in the pericardial cavity are extremely rare, with only a few cases reported up to now. We report here on an epicardial cyst occurring coincidentally with constrictive pericarditis for the first time in the literature. © Georg Thieme Verlag KG Stuttgart

Comparison of EuroScore and STS (The Society of Thoracic Surgeons) risk scoring systems in isolated coronary artery bypass surgery [Koroner bypass cerrahi·si·nde EuroScore ve STS (The Society of Thoracic Surgeons) ri·sk skorlama yöntemleri·ni·n karşilaştirilmasi]

Objective: To compare the feasibility of the EuroScore and STS (The Society of Thoracic Surgeons) risk scoring systems for predicting the surgical mortality of isolated coronary artery bypass surgery patients. Materials and Methods: The risk scoring of 148 patients who were operated on between November 2002 and December 2005 was performed prospectively according to the EuroScore and STS risk scoring systems. The predicted and observed mortality rates according to each scoring system were compared. Results: Hospital mortality was 2% (3 patients). The predicted mortality rate according to EuroScore was 3.4±2.2%, whereas it was 3.0±2.1% for STS. There were no significant differences between predicted and observed mortality rates according to either scoring system. The area under the receiver operating characteristic curve was 0.83 for EuroScore and was 0.82 for STS (p>0.05). Conclusion: Both scoring systems were efficient for predicting mortality rates for our patient population. It is an advantage of STS that it also gives valuable information about morbidity

Intraoperative and histochemical comparison of the skeletonized and pedicled internal thoracic artery

Background. Skeletonization of the internal thoracic artery (ITA) has advantages, but the variation of ITA preparation may be traumatic for the arterial wall. We sought to compare intraoperative results and endothelial nitric oxide synthase (e-NOS) expression on the vessel wall after left ITA harvesting with skeletonization and the conventional technique. Methods. A prospective evaluation of 84 consecutive patients undergoing coronary artery bypass grafting was performed: 40 patients with skeletonized and 44 patients with pedicled left ITA. The lengths of ITA and free ITA blood flow were measured. Distal ITA segments were analyzed histopathologically and stained by antibodies against e-NOS. Results. In the skeletonized group, the length of the ITA were significantly longer than in the pedicled group (15.7 ± 0.4 cm versus 19.0 ± 0.6 cm; P = .001). Also, the free-flow capacity of the ITA was significantly higher than in the pedicled group (62.4 ± 4.8 mL/min versus 88.6 ± 6.9 mL/min; P = .001). e-NOS expressions on endothelial cells were similar between the groups. Dense e-NOS immunostaining was observed in vaso vasorum of the adventitia in the pedicled group. However, there was not any e-NOS immunostaining in vaso vasorum of the adventitia in the skeletonized group. Conclusions. Although skeletonization of the ITA is a more technically demanding procedure, it provides some advantages such as increased available graft length and reduced sternal devascularization. This technique did not have any detrimental effects on the endothelial cell lining and e-NOS expressions on the endothelial layer. To reach a definitive judgment for using skeletonized ITA, we need information about the long-term angiographic patency rates. © 2007 Forum Multimedia Publishing, LLC

Right coronary system grafts: Alone or together with left system grafts - Angiographic results

Purpose: The aim of this study is to compare the long-term graft patency between patients who had sequential or individual right posterior descending artery (RPDA) anastomosis. Materials and Methods: Two hundred and forty-two patients underwent coronary artery bypass grafting (CABG) between June 1994 and December 2003. They were examined retrospectively with respect to coronary angiograghic data. [Group 1] Individually right system grafts in RPDA position (n=139). [Group 2] RPDA anastomosis sequentially with left system (n=103). Patency rates for posterior descending arteries in each group were separately calculated for each vessel quality category. Results: The mean interval from operation to angiography was 50.6±48.9 months in group 1 vs 57.5±39.2 months in group 2 respectively. The overall patency rate was 66.2% (92/139) in group 1 and 78.6% (81/103) in group 2 (p=0.04). When the RPDA has good run-off capacity, the patency rate was 69.1% in group 1 and 85.2% in group 2. Conclusion: When the RPDA has good run-off capacity, snake grafts show excellent results and right and left coronary systems could be anastomosed sequentially