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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coronary angioplasty is sometimes thought to be insufficiently validated considering the considerable development it has undergone and its place in modern cardiological practice. Nevertheless, several randomised clinical trials comparing angioplasty with medical therapy in stable angina (ACME) and with surgical treatment in stable and unstable angina (RITA) have provided more scientific support for the technique. The serious perioperative complications have become rare, the limiting factor being restenosis which is responsible for a large number of clinical recurrences and the reappearance of documented myocardial ischaemia. It is therefore logical to make restenosis the first objective of evaluation of PTCA. There are two possible approaches to this problem. The first relies on automatic quantitative operator-independent angiography as a gold standard. However, this method is methodologically complex, technically fastidious and only takes into consideration the anatomical appearances, the correlations with clinical outcome and prognosis of which are poor. It allows measurement of the amplitude of the process which is an unquestionable advantage, but it is only a partial view of the problem. The second method considers that only stenosis causing ischaemia is significant and that the criterion of evaluation should be the rate of new events and that the necessity of repeated attempts at revascularisation is the criterion of failure of the method. This overlooks the possibility of an anti-restenosis drug producing clinical results independents of its anatomical effect. Both methods have their advantages and drawbacks, which necessitates using them both in all trials of new tools or new molecules designed to prevent restenosis.
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PMID:[Coronary angioplasty: methods of evaluation]. 778 34

Free arterial grafts were aggressively placed in 39 patients (1991 to 1993). There were 34 males and 5 females, and mean age was 59.9 year old. Of 85 arterial grafts, 41 were free grafts, and their materials included left and right internal thoracic artery (LITA, RITA) and right gastroepiploic artery (GEA). There were one free LITA-left anterior descending coronary artery (LAD), seven free RITA-LAD, three free RITA-diagonal branch (Dx), 14 free RITA-left circumflex coronary artery (LCX), 10 free RITA-right coronary artery (RCA), two sequential RITA-Dx-LCX, one free GEA-Dx, two free GEA-LCX, and one free GEA-RCA bypass. Of 41 free arterial grafts, 38 were in the aorta-coronary position, and the proximal anastomosis was constructed first under single aortic cross-clamping to get the larger anastomotic sites for both at the proximal and distal ends of the arterial graft. The proximal sites of the remaining 3 arterial grafts were placed to concomitantly utilized saphenous vein grafts in two patients and RCA in one patient because of their shortness. Perioperative complications included no exploration for bleeding, myocardial infarction in one (2.6%), intra-aortic balloon pumping in three (7.7%), and wound complications in two (5.1%). 28 cases (72%) were completely revascularized with only arterial grafts. Of 41 free arterial grafts studied within one month after operation, all grafts were patent. All patients were free from angina after a 27 months mean follow-up. We believe that the proximal anastomosis technique for free arterial graft we used could be acceptable alternative for many surgeons. These excellent results justify wider use of free arterial grafts.
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PMID:[Free arterial graft for coronary bypass grafting]. 786 Oct 54

The incidence of reoperative coronary artery bypass grafting (reCABG) is recently increasing. However, there has been no report of reCABG in patients with patent internal thoracic artery (ITA) grafts in Japan. We performed reCABG in three such patients with patent ITA grafts. The first patient was a 49-year-old male who had undergone a 2 CABG (left ITA-LAD, SVG-DX 1), 8 years and 7 months prior to the 2nd operation, he received a re 2 CABG (GEA-RCA, RITA-SVG-DX 1) with a patent prior LITA-LAD graft. The second patient was a 65-year-old female who had undergone CABG in which the LITA had been erroneously anastomosed to the DX 2 in place of the LAD. Three year later, the reCABG (RITA-LAD) was performed with a patent prior LITA-DX 2 graft. The third patient was a 51-year-old male who had undergone 3-CABG (RITA-LAD, LITA-DX, SVG-RCA). The RITA was closed most probably due to technical errors and his angina recurred. Tree year after the first operation, he received a re 3-CABG (GEA-LAD, SVG-RCA, SVG-OM) with a patent prior LITA-DX graft. In each patient, PTCA had been tried twice, twice and once prior to redo operations. Their post-redo courses were uneventful, and they were discharged free from angina. In such cases it is important to manage with care the patent ITA grafts at reoperation. Biplane ITA angiograms are quite helpful to evaluate the course of grafts in relation to the sternum. To cover the ITA graft with a GORE-TEX membrane may also be useful for easy identification of the graft at redo operations.
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PMID:[Reoperative coronary artery bypass grafting in patients with patent internal thoracic artery grafts]. 796 79

The current trend in myocardial revascularization is to use arterial grafts in most, if not all cases. The right internal thoracic artery was a logical choice once the left internal thoracic artery patency on the LAD was known. This study presents our experience of using both attached internal thoracic arteries (ITA). Between January and October 1990, 159 myocardial revascularizations were performed in our department. In 117 cases, bilateral ITA grafting was used with non exclusion criteria. There were 100 male and 17 female patients, with a mean age of 61 +/- 8. The LITA was anastomosed to the LAD in 44 cases, and to the marginal artery in 74. The RITA was anastomosed to the LAD in 68 cases, to the marginal artery in 47 and to the right coronary artery in 2. An average of 3.5 bypasses per patient, including saphenous vein grafts, were performed. Six patients (5%) died within 30 days. Four patients (3.4%) were diagnosed as having periperative myocardial infarcts. There were no reoperations for bleeding. One patient (0.9%) presented a sternal wound infection. Mean follow-up was 18 +/- 7 months. Six patients died during the follow-up and the survival rate was 91%. Ninety-five patients (91%) were symptom-free, 9 patients had a recurrent angina. Postoperative coronary angiography was performed in 11 patients (10%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Myocardial revascularization using both attached internal thoracic arteries. Mid-term clinical evaluation of 117 cases. 853 2

A 52-year-old man with reduced left ventricular function (ejection fraction 0.27) due to myocardial infarction, underwent coronary artery bypass grafting (CABG; LITA-LAD, free RITA-4PD) for angina pectoris. He had suffered from recurrent sustained ventricular tachycardia (VT) since 5 hours after CABG. This arrhythmia was resistant to various antiarrhythmic agents such as Lidocaine, Mexiletine, Disopyramide, Procainamide and Propafenone. He required mechanical circulatory supports (intra-aortic balloon pumping and percutaneous cardiopulmonary support) for the maintenance of hemodynamics during repeated VT that required cardioversions of a total of 441 times during 18 days. Following the administration of Amiodarone, the VT was successfully suppressed. However, he had repeated episodes of VT on exercise, thus, he underwent insertion of the implantable cardioverter-defibrillator at the 98 post-operative day, and he was successfully discharged at the 134 post-operative day after CABG. The instrument was verified to be normal in function after the VT induction test.
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PMID:[Life-threatening ventricular tachyarrhythmia after CABG in a patient with poor LV function--an experience with the implantable cardioverter defibrillator]. 930 Dec 41

We experienced two patients with single coronary artery who underwent CABG using arterial grafts successfully. In two patients coronary angiography demonstrated a single coronary artery which was originated in left coronary sinus and was bifurcated to LAD and LCx, and then RCA branched off proximal LAD, passing in front of the right ventricular out flow tract (Sharbaugh Type L-IIa). To the first patient, a 52-year-old man who had angina on exertion due to long stenosis of RCA, CABG to RCA using RITA was carried out. To the second patient, a 57-year-old man who had inferior myocardial infarction due to 90% stenosis of proximal LAD, CABG to RCA using RITA and LAD using LITA was carried out. Single coronary artery without additional congenital cardiac anomalies may lead to myocardial ischemia, necessitating CABG as coronary reconstructions.
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PMID:[Coronary artery bypass grafting in two patients with single coronary artery]. 1003 76

Stable angina is a common clinical condition in everyday practice. Several studies (ACME, MASS, RITA 2) compared the efficacy of angioplasty with medical management in this context with concordant results: significant reduction in the frequency of angina and improved exercise capacity, without reduction in the number of serious events (death, infarction). Even though developments in the field of angioplasty have provided better clinical results, especially with the use of stents, the indication of dilatation should be clearly defined by a series of clinical and angiographic parameters. Although resistance to well conducted medical treatment is an indication for revascularisation when possible, the indications should be reconsidered if persistent ischaemia with medical therapy has not been proved.
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PMID:[Treatment of stable angina. Coronary angioplasty versus medical treatment]. 1059 42

Case 1: A 72-year-old woman with effort angina underwent coronary artery bypass grafting. A preoperative coronary angiogram showed 90% stenosis in the proximal main RCA, and total occlusion in the proximal LAD, distal of which was an area well supplied by collaterals from the RCA. This patient had previously undergone right upper lobectomy due to lung cancer. With a skin incision of 8 cm, the LITA was inserted into the LAD and the RITA was inserted into the mid RCA through an inferior mini-sternotomy while the heart was beating. Case 2: A 69-year-old man with effort angina underwent CABG. A preoperative coronary angiogram showed 90% stenosis in the proximal main RCA, 75% stenosis in the PDA and total occlusion in the proximal LAD, distal of which was an area well supplied by collaterals from the RCA. With a skin incision of 11 cm, the LITA was inserted into the LAD, the RITA into the mid-RCA and the radial artery graft attached to the RITA was grafted to the PDA through an inferior mini-sternotomy while the heart was beating. In both cases, the sternum was not cut transversely in order to prevent injury to the ITAs and pseudo-joint formation. With the use of this technique, exposure of the LAD and RCA was excellent. Postoperative recovery in both patients was uneventful and postoperative angiograms revealed widely patent grafts. This technique was very useful when performing off-pump CABG using bilateral ITAs.
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PMID:[Inferior mini-sternotomy for off-pump CABG using bilateral internal thoracic arteries]. 1121 68

Is a "routine invasive" or "selective invasive" strategy the best approach for patients with non-ST-segment elevation acute coronary syndrome (ACS)? A "selective invasive" strategy incorporates ischemia-guided use of aggressive medical therapy followed by angiography and revascularization for angina or stress-induced myocardial ischemia. The "routine invasive" strategy (cardiac catheterization followed by percutaneous coronary intervention within 24 to 48 h of symptom-onset) is frequently employed, but no randomized, controlled trials have demonstrated improved clinical outcomes. Recently, the second Fragmin and fast Revascularization during InStability in Coronary artery disease (FRISC-II) and the Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction (TACTICS TIMI-18) trials found significant reductions in death, recurrent myocardial infarction, or hospitalization for biomarker-positive ACS. Also, the third Randomized Intervention Trial of unstable Angina (RITA-3) recently reported a halving of refractory angina and reduction in the use of antianginal medication with early intervention. Early trials failed to demonstrate the superiority of the "routine invasive" approach, presumably because of fewer revascularizations, unavailability of stents, and more recent use of glycoprotein IIb/IIIa inhibitors and low-molecular-weight heparins. The FRISC-II, TACTICS TIMI-18, and RITA-3 studies indicate that higher-risk patients benefit from early revascularization, but that aggressive antiplatelet, antithrombin, and anti-ischemic therapy are also important. While all three trials support an "early invasive" approach in intermediate- and high-risk patients, other trials support a more "conservative" approach in those without electrocardiographic changes or enzyme elevations. Optimal management should incorporate both strategies.
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PMID:"Routine invasive" versus "selective invasive" approaches to non-ST-segment elevation acute coronary syndromes management in the post-stent/platelet inhibition era. 1264 49

Between May 1997 and November 2002, 68 patients with one or two-vessel disease (55+/-9 years) underwent Port Access CABG using the Heartport endoCPB. The LITA was used in 63 cases, the RITA in 14, a radial artery in 2 and a vein graft in 3. Mean distal anastomoses was 1.3+/-0.5. Cross clamping, CPB, and operative times were 42+/-20 min, 64+/-27 min, and 3.8+/-1.5 h. Postoperative ventilation was 11+/-17 h, and ICU stay was 1.9+/-2.6 days. At day-1, troponin level was 2.3+/-2.9 UI and blood loss was 398+/-240 ml. Two patients needed long intubation and two had pleural re-drainage. One patient had a stroke, one had a myocardial infarction, and one underwent revision for bleeding. Hospital stay was 7+/-3 days. 65% were discharged to home. Follow up was completed in all cases (4.1+/-1.8 years). CCS score was significantly reduced (from 3.1+/-0.3 to 1.1+/-0.3, P<0.0001). Two patients had PTCA and stenting of non-grafted arteries. Five other patients had recurrent angina. Angiograms showed patent grafts in all cases. Two patients died after 19 months and 5 years from non cardiac reasons. In conclusion, Port Access CABG remains a safe technique with stable results at mid-term follow up.
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PMID:Which place for Port Access surgery in coronary artery bypass grafting? A mid-term follow up study. 1767 May 17


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