Journal of Yeungnam Medical Science

Original article

Surgical results of only antegrade del Nido cardioplegia infusion in conventional coronary artery bypass grafting: a retrospective study: Sang-Uk Park, Yo Han Bae, Yun Seok Kim, Kyungsub Song, Woo Sung Jang; J Yeungnam Med Sci. 2023;40(Suppl):S23-S28. Published online June 28, 2023; DOI: https://doi.org/10.12701/jyms.2023.00283

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Abstract PDF: Background
Additional retrograde cardioplegia infusion in conventional coronary artery bypass grafting (CABG) was introduced to address the concern of inappropriate cardioplegia delivery through the stenotic coronary artery. However, this method is complex and requires repeated infusions. Therefore, we investigated the surgical outcomes of only antegrade cardioplegia infusion in conventional CABG.
Methods
We included 224 patients who underwent isolated CABG between 2017 and 2019. The patients were divided into two groups according to the cardioplegia infusion method: antegrade cardioplegia infusion with del Nido solution (n=111, group I) and antegrade+retrograde cardioplegia infusion with blood cardioplegia solution (n=113, group II).
Results
The sinus recovery time after release of the aorta cross-clamp was shorter in group I (3.8±7.1 minutes, n=98) than in group II (5.8±4.1 minutes, n=73) (p=0.033). The total cardioplegia infusion volume was lower in group I (1,998.6±668.6 mL) than in group II (7,321.0±2,865.3 mL) (p<0.001). Creatine kinase-MB levels were significantly lower in group I than in group II (p=0.039). Newly developed regional wall motion abnormalities on follow-up echocardiography were detected in two patients (1.8%) in group I and five patients (4.4%) in group II (p=0.233). There was no significant difference in ejection fraction improvement between the two groups (3.3%±9.3% in group I and 3.3%±8.7% in group II, p=0.990).
Conclusion
The only antegrade cardioplegia infusion strategy in conventional CABG is safe and has no harmful effects.

Case Reports

Acute left main coronary artery thrombosis as an initial presentation of systemic lupus erythematosus: Kang Un Choi, Ung Kim; Yeungnam Univ J Med. 2018;35(2):227-231. Published online December 31, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.2.227

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Abstract PDF: Left main coronary artery (LMCA) thrombosis is rare and the cause should be determined. A previously healthy young man presented with severe chest pain and dyspnea. The electrocardiogram showed typical ST-segment elevation myocardial infarction with clinical instability. Emergency coronary angiography revealed complete LMCA occlusion by thrombosis. After reperfusion, the patient was admitted to the cardiac care unit. He was diagnosed with hemolytic anemia and tested positive for antinuclear antibodies. Systemic lupus erythematosus (SLE) and LMCA disease due to systemic thrombosis were diagnosed. Steroids were started and the patient was discharged without complications. We report this rare case of LMCA thrombosis as an initial presentation of SLE.

Successful transradial intervention via a radial recurrent artery branch from the radioulnar alpha loop using a sheathless guiding catheter: Shin-Eui Yoon, Sangwook Park, Sung Gyun Ahn; Yeungnam Univ J Med. 2018;35(1):94-98. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.94

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Abstract PDF

The radial artery is generally the preferred access route in coronary angiography and coronary intervention. However, small size, spasm, and anatomical variations concerning the radial artery are major limitations of transradial coronary intervention (TRI). We describe a successful case involving a patient with coronary artery disease who underwent TRI via a well-developed radial recurrent artery branch from the radioulnar alpha loop using a sheathless guiding catheter.

Citations

Citations to this article as recorded by

Minimizing Guidewire Unwilling Passage and Related Perforation During Transradial Procedures: Prevention Is Better Than Cure
Lili Xu, Jiatian Cao, Meng Zhang, Hongbo Yang, Zheyong Huang, Yanan Song, Chenguang Li, Yuxiang Dai, Kang Yao, Xiangfei Wang, Feng Zhang, Juying Qian, Junbo Ge
Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef

Multi-vessel intractable coronary spasm development in a patient with aborted sudden cardiac death: a case study with intravascular ultrasound findings: Sungsoo Cho, Tae Soo Kang; Yeungnam Univ J Med. 2018;35(1):121-126. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.121

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Abstract PDF

Coronary spasm generally occurs in patients with minimal atherosclerotic plaque lesion, and it has a rather favorable prognosis. However, in some cases, coronary spasm may induce myocardial infarction and even sudden cardiac death (SCD). Here, we report a case in which multi-vessel intractable coronary vasospasm suddenly occurred in a diffuse atherosclerotic lesion after percutaneous coronary intervention (PCI) in a patient with aborted SCD. We identified the characteristics of the spasm portion in intravascular ultrasound (IVUS) images and conducted percutaneous cardiopulmonary bypass support-PCI with stenting as treatment. Intima and media thickening and a large attenuated plaque burden with rupture were identified in IVUS images at the obstructive spasm portion.

Citations

Citations to this article as recorded by

Intractable right coronary artery spasm in the early postoperative period after heart transplantation: a case report
Jaewook Chung, Jeehoon Kang, Hae-Young Lee, Suk Ho Sohn, Ho Young Hwang, Hyun-Jai Cho
Korean Journal of Transplantation.2022; 36(2): 154. CrossRef

Original Article

Long-term clinical outcome of acute myocardial infarction according to the early revascularization method: a comparison of primary percutaneous coronary interventions and fibrinolysis followed by routine invasive treatment: Hyang Ki Min, Ji Young Park, Jae Woong Choi, Sung Kee Ryu, Seunghwan Kim, Chang Sup Song, Dong Shin Kim, Chi Woo Song, Se Jong Kim, Young Bin Kim; Yeungnam Univ J Med. 2017;34(2):191-199. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.191

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Abstract PDF: BACKGROUND
This study was conducted to provide a comparison between the clinical outcomes of primary percutaneous coronary intervention (PCI) and that of fibrinolysis followed by routine invasive treatment in ST elevation myocardial infarction (STEMI). METHODS: A total of 184 consecutive STEMI patients who underwent primary PCI or fibrinolysis followed by a routine invasive therapy were enrolled from 2004 to 2011, and their major adverse cardiovascular events (MACEs) were compared. RESULTS: Among the 184 patients, 146 patients received primary PCI and 38 patients received fibrinolysis. The baseline clinical characteristics were similar between both groups, except for triglyceride level (68.1±66.62 vs. 141.6±154.3 mg/dL, p=0.007) and high density lipoprotein level (44.6±10.3 vs. 39.5±8.1 mg/dL, p=0.005). The initial creatine kinase-MB level was higher in the primary PCI group (71.5±114.2 vs. 35.9±59.9 ng/mL, p=0.010). The proportion of pre-thrombolysis in MI 0 to 2 flow lesions (92.9% vs. 73.0%, p < 0.001) was higher and glycoprotein IIb/IIIa inhibitors were administered more frequently in the primary PCI group. There was no difference in the 12-month clinical outcomes, including all-cause mortality (9.9% vs. 8.8%, p=0.896), cardiac death (7.8% vs. 5.9%, p=0.845), non-fatal MI (1.4% vs. 2.9%, p=0.539), target lesion revascularization (5.7% vs. 2.9%, p=0.517), and stroke (0% vs. 0%). The MACEs free survival rate was similar for both groups (odds ratio, 0.792; 95% confidence interval, 0.317–1.980; p=0.618). The clinical outcome of thrombolysis was not inferior, even when compared with primary PCI performed within 90 minutes. CONCLUSION: Early fibrinolysis with optimal antiplatelet and antithrombotic therapy followed by appropriate invasive procedure would be a comparable alternative to treatment of MI, especially in cases of shorter-symptom-to-door time.

Case Reports

Severe chest pain with mid-ventricular obstruction in a patient with hyperthyroidism: Jong Ho Nam, Jang Won Son, Geu Ru Hong; Yeungnam Univ J Med. 2017;34(1):128-131. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.128

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Abstract PDF: Mid-ventricular obstruction (MVO) rarely occurs in patients without hypertrophic cardiomyopathy. Increased cardiac contractility may play an important role in causing MVO. We experienced a case of severe chest pain and MVO in a 50-year-old female patient. She had hypertension, diabetes, stroke and peripheral artery disease. Her blood pressure was very high (222/122 mmHg) with severe fluctuation. The transthoracic echocardiography revealed MVO accompanied by hyper-dynamic left ventricular systolic function. We regarded her chest pain and MVO as secondary findings related to other diseases. Coronary angiography and several tests for uncontrolled hypertension were performed, and those evaluations revealed that she had coronary artery disease and hyperthyroidism. We considered that the increase in the myocardial oxygen demand in response to the increase in cardiac contractility and workload associated with hyperthyroidism aggravated her symptoms and MVO. She was treated with methimazole and beta blockers and her symptoms dramatically improved.

Acute myocardial infarction with a giant left main aneurysm in atypical Kawasaki disease: Min Wook Kim, Hyun Soo Kim, Myung Dong Lee, Hyun Sook Jung, Seong Bo Yoon, Young Woo Kim; Yeungnam Univ J Med. 2017;34(1):106-110. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.106

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Abstract PDF: Kawasaki disease (KD) is an acute vasculitis of small and medium sized arteries. Even many years after onset, aneurysms and stenosis in coronary arteries may lead to an acute myocardial infarction, which is described as atypical or missed KD in childhood. KD is an underlying disease of young adults with acute myocardial infarction. We report on a rare case involving a total occlusion in the proximal left anterior descending coronary artery combined with a giant left main aneurysm in a young adult patient with acute myocardial infarction ascribed to antecedent KD that is undefined but almost certain.

Retrieval of a dislodged and dismounted coronary stent; using a rendezvous and snare technique at the brachial artery level via femoral approach.: Min Woong Jeong, Chang Bae Sohn, Su Hong Kim, Jong Ik Park, Se Ryeong Park, Jun Sik Min; Yeungnam Univ J Med. 2016;33(2):138-141. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.138

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Abstract PDF: Coronary stent dislodgement during percutaneous coronary intervention, which occurs when the stent is passed through tortuous and calcified lesions, is not a rare complication. Without proper treatment, such as fixing with another stent in the coronary artery or removing the undeployed stent from the coronary artery or systemic artery system, this complication can cause serious problems. We experienced the unusual situation of a dismounted and dislodged coronary stent, in which retrograde retrieval to the radial artery was impossible during transradial coronary intervention. We report on use of a rendezvous and snare technique at the brachial artery level via femoral puncture, which resulted in resolution without surgery.

Guide wire fracture during percutaneous coronary intervention.: Hak Ro Kim, Tae Hoon Yim, Byung Chul Kim, Ho Jun Lee, Hong Geun Oh, Hyun Sik Ju, Tae Jin Kim, Young Bok Kim; Yeungnam Univ J Med. 2016;33(1):52-55. Published online June 30, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.1.52

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Abstract PDF: Guide wire fracture during percutaneous coronary intervention (PCI) is rare. It can cause fatal complications such as thrombus formation, embolization, and perforation. Guide wire fracture could occur during intervention for severely calcified stenotic lesions, and rarely from distal small branches of stenotic lesions. There are several methods for its management depending on the material character, position, length of the remnant, and the patient's condition. If percutaneous retrieval was not achieved, the surgical procedure should be considered for prevention of potential risks, although the remnant guide wire does not usually cause complications. We experienced a patient with a guide wire fracture during PCI, and managed to prevent its complications through surgical removal of the remnant wire. We report this case here.

Implantation of a permanent pacemaker through the coronary sinus in a patient who underwent mechanical valve replacement for infective endocarditis with a complete atrioventricular block.: Kwan Hoon Jo, Inho Kim, Soe Hee Ann, Yong Seog Oh; Yeungnam Univ J Med. 2014;31(2):113-116. Published online December 31, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.2.113

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Abstract PDF: A 52-year-old man was referred to our hospital due to fever and myalgia that occurred 2 weeks earlier. He showed a complete atrioventricular block on his electrocardiogram, and his vital signs were unstable. On his transthoracic echocardiograph, the 1.5 cm vegetation in the aortic valve with severe aortic regurgitation suggested infective endocarditis. His transesophageal enchocardiograph showed abscess in his mitral-aortic intervalvular fibrosa and vegetation was suspected on his anterior mitral valve leaflet. The patient underwent an emergent operation for valve replacement with temporary epicardial pacing. Intraoperatively, the septal leaflet of his tricuspid valve was injured during the debridement of the abscess pocket that was extended to the membranous septum. The aortic, mitral, and tricuspid mechanical valves were replaced with annular reconstruction without complications. After 14 days of intravenous antibiotics, we successfully changed the epicardial pacemaker into a transvenous DDD-type permanent pacemaker by placing a left ventricular lead via the coronary sinus and an atrial lead in the right atrium appendage. The patient was discharged in a tolerable state and was examined uneventfully in our hospital's outpatient clinic for 8 months.

Dual left anterior descending coronary artery originating from left main stem and right coronary sinus.: Dong Hwi Kim, Keon Woong Moon, Eun Hee Kim, Gihyeon Woo, Jin Kyeong Shin, Ji Yeun Jang, Sungeun Ha, Joo Young Lee; Yeungnam Univ J Med. 2014;31(1):13-16. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.13

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Abstract PDF: Congenital abnormalities of the coronary arteries are found in 0.6% to 1.3% of patients in coronary angiography. Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is incidentally detected during coronary angiography. We report a case of a 65-year-old female with a rare coronary anomaly who was diagnosed with dual LAD via coronary computed tomography and coronary angiography. The imaging studies revealed dual LAD originating from the left main stem and right coronary sinus. These angiographic findings were considered to be consistent with the type IV variety of dual LAD by Spindola-Franco classification. Recognition of dual LAD is important to prevent errors of interpretation of the coronary angiogram and for optimal surgery.

Severe Mitral Regurgitation Due to Coronary Vasospasm, Confirmed by Ergonovine Echocardiography.: Jung Joon Cha, Chan Hee Kyung, Jang Ho Cho, Yong Hoon Kim, Haewon Kim, Sung Joo Lee, Se Joong Rim, Eui Young Choi; Yeungnam Univ J Med. 2013;30(2):120-123. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.120

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Abstract PDF: The common causes of organic mitral regurgitation (MR) include mitral valve prolapse (MVP) syndrome, rheumatic heart disease, and endocarditis. MR also occurs secondary to dilated cardiomyopathy and coronary artery disease. In acute severe MR, the hemodynamic overload often cannot be tolerated, and mitral valve repair or replacement must be performed immediately. We report herein a case of severe MR due to coronary vasospasm that was confirmed via ergonovine echocardiography in a 70-year-old man. He was scheduled to undergo mitral valve surgery, but it did not push through and he was put on medical therapy.

A Case of Successful Recovery from High Dose Intravenous Nicorandil Infusion in Refractory Coronary Vasospasm with Hemodynamic Collapse.: Won Jun Koh, Jeong Hyeon Cho, Ji Hyun Lee, Won Sik Kang, Min Kyung Lee, Jun Hyoung Kim, Deok Kyu Cho; Yeungnam Univ J Med. 2012;29(2):129-131. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.129

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Abstract PDF: A 70-year-old male came to the emergency room of the authors' hospital because of sudden cardiac arrest due to inferior wall ST elevation myocardial infarction. His coronary angiography revealed multiple severe coronary spasms in his very long left anterior descending artery. After an injection of intracoronary nitroglycerine, his stenosis improved. The cardiac arrest relapsed, however, accompanied by ST elevation of the inferior leads, while the patient was on diltiazem and nitrate medication to prevent coronary spasm. Recovery was not achieved even with cardiac massage, intravenous injection of epinephrine and atropine, and intravenous infusion of nitroglycerine. The patient eventually recovered through high-dose nicorandil intravenous infusion without ST elevation of his inferior leads. Therefore, intravenous infusion of a high dose of nicorandil must be considered a treatment option for cardiac arrest caused by refractory coronary vasospasm.

A Case of Aberrant Right Subclavian Artery (Arteria Lusoria) with Chest Tightness and Coughing.: Seung Hee Han, Su Young Kim, Hye Kyong Park, Jong Sung Park; Yeungnam Univ J Med. 2012;29(1):61-64. Published online June 30, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.1.61

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Abstract PDF: The left aortic arch with an aberrant right subclavian artery, or arteria lusoria, is the most common aortic arch anomaly, occurring in 0.5-2.5% of individuals. In such cases, the angular course of the arteria lusoria to the ascending aorta imposes difficulty in passing a guide wire to the ascending aorta during right transradial catheterization. Here, the case of a 53-year-old woman with intermittent chest tightness and coughing is reported. Aberrant right subclavian artery (arteria lusoria) was diagnosed via aortogram during right transradial coronary angiography. Compression of the esophagus and trachea by the aberrant right subclavian artery was demonstrated by chest computed tomography (CT).

Original Article

Effects of Combined Antiplatelets on Bleeding in Off-Pump Coronary-Artery Bypass Surgery.: Su Kyeong Lee, Tae Jin Kim, Song Yun Seok, Sun Ho Jung, Kyung Ho Yang, Kang Joo Choi, Young Bok Kim; Yeungnam Univ J Med. 2011;28(2):124-132. Published online December 31, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.2.124

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Abstract PDF: BACKGROUND
Antiplatelet agent administration is critical in managing coronary-artery disease, but there is a concern regarding operation-related bleeding and an increase in blood transfusion in such, especially when delivering combined antiplatelet agents. This study was conducted to evaluate the effect of the administration of antiplatelet agents on off-pump coronary-artery bypass surgery (OPCAB). METHODS: From March 2003 to December 2009, 49 patients who had undergone OPCAB were collected retrospectively. The patients were divided into three groups according to the administration of antiplatelet agents before the OPCAB operation: 21 patients were given an aspirin agent (group 1), 19 patients were given combined agents (aspirin+clopidogrel) (group 2), and nine patients were not given any antiplatelet agent (group 3). The three groups' perioperative hematologic and coagulation profiles, including their platelet counts, hemoglobin levels, hematocrit, prothrombin times, and aPTTs (activated partial thromboplastin times), and their postoperative bleeding, related complications, transfusion requirements, and operation times, were compared. RESULTS: The operation time in group 2 was 4.3 hours, longer than those in the two other groups, and urgent operation was significantly most frequent in group 2 (63%). The amount of blood loss and the number of patients who received blood transfusion were not different in the three groups. The perioperative hemoglobin level, hematocrit, platelet count, prothrombin time, and aPTT were also not significantly different among the three groups. CONCLUSION: The continuous administration of antiplatelet agents to the patients in this study did not increase their postoperative bleeding or operation-related complications. Therefore, OPCAB may well be considered even if combined antiplatelet agents are being administered.

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