Aortocoronary Bypass in the Treatment of Left Main Coronary Artery Stenosis
|
|
- Virgil Cannon
- 5 years ago
- Views:
Transcription
1 Aortocoronary Bypass in the Treatment of Left Main Coronary Artery Stenosis W. C. Alford, Jr., M.D., I. J. Shaker, M.D., C. S. Thomas, Jr., M.D., W. S. Stoney, M.D., G. R. Burrus, M.D., and H. L. Page, M.D. ABSTRACT Because of the high risk of sudden death, coronary cineangiography should be done with caution in patients with possible left main coronary artery (LMCA) stenosis. After confirmation of LMCA stenosis, these patients should undergo careful monitoring; and aortocoronary artery bypass procedures, when technically feasible, have urgent priority. This report contains data on 104 patients with LMCA stenosis from St. Thomas Hospital in Nashville who were managed in this way. Eighty-six subsequently had coronary artery bypass grafting. There were 7 operative deaths and 2 late cardiac deaths in 38 months of follow-up observations. When compared with nonoperated patients with similar angiographic findings, the operated group showed considerably greater survival. Certain modifications of the usual operative techniques are described which tend to lessen the operative risk in patients with LMCA stenosis. S ignificant stenosis (greater than 50%) of the left main coronary artery (LMCA) is the most ominous single coronary artery lesion demonstrable by coronary arteriography. The high early mortality in unoperated patients has been well documented. This group of patients provides the most critical test of aortocoronary bypass as a procedure capable of prolonging life as well as decreasing symptoms of myocardial ischemia. The effectiveness of bypass grafting in altering survival has been partially negated in previous reports by a considerable operative mortality. The results of surgical treatment in 86 patients with LMCA stenosis operated upon at St. Thomas Hospital, Nashville, are presented. This experience demonstrates that low operative mortality is attainable and that patients treated surgically show considerably greater survival than previously reported nonoperated patients. Clinical Material and Methods Patient records covering 2,360 coronary angiograms performed at the St. Thomas Hospital between 1968 and 1973 were reviewed by one of the authors (H. L. P.). Only patients with greater than 50% stenosis of the From the Cardiac Surgical Service and the Department of Cardiology, St. Thomas Hospital, Nashville, Tenn. Supported in part by U.S. Public Health Service Grant 5T01-GM Presented at the Twentieth Annual Meeting of the Southern Thoracic Surgical Association. Louisville, Ky., Nov. 1-3, Address reprint requests to Dr. Alford, 2108 West End Ave., Nashville, Tenn VOL. 17, NO. 3, MARCH,
2 ALFORD ET AL. A B C FIG. 1. Cineangiography frames showing left main coronary artery stenosis (arrows): (A) ostial stenosis, (B) localized stenosis, and (C) diffuse stenosis. LMCA were selected for retrospective analysis (Fig. 1). Follow-up clinical information was obtained on each patient. In most instances, selective coronary cineangiography was performed by the transfemoral technique. Those patients suspected of having potential LMCA lesions-i.e., patients with severe or crescendo angina pectoris, unusually positive resting or treadmill electrocardiograms, LMCA calcification, or damping of the pressure contour as shown by monitoring during intubation of the left coronary ostium-were rotated into a moderately shallow right anterior oblique position for better visualization of the LMCA during the first left coronary injection. Since attempts at nonselective opacification are frequently suboptimal, the injection was performed selectively and the catheter was immediately withdrawn to facilitate washout of the contrast material. With this modified technique, the number of injections was minimized and a single, well-opacified view was often obtained (Fig. 2). Patients with demonstrable LMCA stenosis of greater than 50% underwent urgent aortocoronary bypass procedures. Certain modifications of the usual operative technique were utilized in these patients in order to decrease complications. The radial artery and central venous pressure monitoring catheters were inserted under local anesthesia. These provided the anesthesiologist with instant pressure measurements during and following induction of anesthesia. Hypotension prior to bypass was scrupulously avoided. After cardiopulmonary bypass was instituted and moderate hypothermia (32 C.) 248 THE ANNALS OF THORACIC SURGERY
3 Aortocoronary Byfiass in Left Main CA Stenosis A FIG. 2. Single-injection views of left and right coronary arteries of the same patient, showing: (A) localixed left main coronary artery stenosis (arrow) and (B) tight midright coronary stenosis (arrow). was achieved, prompt revascularization of the most significant left coronary artery branch (usually the left anterior descending) was performed, followed by other, less urgent grafting procedures. Results Among the 2,360 patients studied by coronary cineangiography for symptoms of angina, congestive heart failure, or arrhythmia, 104 patients (4.4y0) were found to have greater than 50y0 stenosis of the LMCA. The average age of the patients with LMCA stenosis was 55 years, with a range of 33 to 74 years. Ten patients were women and 94 were men. Their clinical signs and symptoms are presented in Table 1 and their electrocardiographic findings in Table 2. Nine patients had a normal resting ECG. Three of these 9 ECGs as well as 5 of the ECGs with nonspecific changes became positive during treadmill exercise stress testing. Fifteen patients had definite evidence of ischemia at rest, 32 had nonspecific ST-T wave abnormalities, and 48 had evidence of previous myocardial infarction. Eighty-six patients underwent urgent aortocoronary artery bypass procedures. The remaining 18 patients were not operated upon because of in- B
4 ALFORD ET AL. TABLE 1. SIGNS AND SYMPTOMS IN 104 PATIENTS WITH LEFT MAIN CORONARY ARTERY STENOSIS' Symptom No. of Patients Recent onset or crescendo angina 49 Stable angina 47 Congestive heart failure 8 Arrhythmia 2 Mitral regurgitation 3 Some patients had more than one symptom. adequacy of distal vessels or ventricular function or because they died shortly after coronary cineangiography, they refused operation, or they were advised against operation by their referring physicians. Three of these 18 patients died suddenly within four days of coronary cineangiography. A fourth patient died of dissecting thoracic aortic aneurysm l month later. An additional patient died suddenly 15 months after cardiac catheterization; thus 5 of the 18 nonoperated patients died within a year and a half of their evaluation. Of the 86 patients who had coronary artery bypass grafts (CABG) inserted, there were 8 single, 37 double, 38 triple, and 3 quadruple grafts (Fig. 3). Three patients underwent concomitant left ventricular aneurysmectomy, and 1 of these also had mitral valve replacement. In the entire op erative group, 7 hospital deaths occurred. Two patients who failed to survive the CABG procedure were in cardiogenic shock and were undergoing cardiopulmonary resuscitation at the time they arrived in the operating room. Three patients died of multiple systems failure. One of these patients had concomitant mitral valve replacement and left ventricular aneurysmectomy. A sixth patient died of pulmonary embolism and arrhythmia on the twentyeighth postoperative day. The seventh patient died of respiratory failure following laparotomy for intestinal obstruction thirty days after the procedure. Thus 5 of the 84 patients who underwent elective operations died, and no deaths have occurred since 1971 (43 patients). The 79 survivors have been followed for a period of 1 to 38 months (mean, 11 months). Only 2 late cardiac deaths have occurred. One patient died of cardiac failure following mitral valve replacement done 4 months TABLE 2. ELECTROCARDIOGRAPHIC FINDINGS IN 104 PATIENTS WITH LEFT MAIN CORONARY ARTERY STENOSIS ECG Findinn Normal Nonspecific ST-T wave changes Ischemia at rest Previous infarction No. of Patients THE ANNALS OF THORACIC SURGERY
5 Aortocoronay Bypass in Left Main CA Stenosis OPERATIVE DEATH m!!ikii% \mtock ELECTIVE CASES FIG. 3. Number of coronary artery 54 1 bypass grafting procedures and 06- eratiue deaths in 86 patients with left main coronary artery stenosis. NUMBER OF GRAFTS PERFORMED PER PATIENT after CABG, and a second patient died of myocardial infarction and ventricular fibrillation 32 months postoperatively. Two additional noncardiac deaths occurred 5 months postoperatively, 1 following an intracerebral hemorrhage and the second due to a Pancoast s tumor of the left lung. If unsuccessful operations for cardiogenic shock in 2 patients and late noncardiac deaths are excluded, the survival following aortocoronary artery bypass at this time is 91.5%. Comment The incidence of LMCA stenosis is not great. Occurrence of this lesion in reported series has varied between 2.50/, (Cohen and associates [3]) and 5.9y0 (Bruschke and colleagues [l, 21). In our series it was 4.4y0. Continued study of this potentially lethal lesion is thus desirable. Two pertinent factors associated with such a study are the predictably high risk of infarction and death after the diagnosis is established and the dangers of cineangiography in these patients. Lavine and co-workers [5] reported a 30% mortality within 1 month of coronary cineangiography. A high nonsurgical mortality was also reported by Bruschke and associates [l] in their series of 37 patients with LMCA stenosis. This increased to , within 5 years and to 74y0 if the right coronary artery was totally obliterated in association with the LMCA lesion. In the series of Cohen and colleagues [3], half of the nonoperated patients died within 25 months. The fact that our nonsurgical mortality of 5 of 18 patients who were followed for 38 months is somewhat lower is thought to be due to modifications of coronary catheterization techniques and perhaps to the smaller number of patients involved. Modified cardiac catheterization is undertaken at the discretion of the cardiologist in any patient suspected of having LMCA stenosis from the cri- VOL. 17, NO. 3, MARCH,
6 ALFORD ET AL. teria previously described. The left ventricle is first examined in the usual manner. The patient is then rotated so that a shallow right anterior oblique view can be obtained, and a left coronary injection is carefully performed. If greater than 50% LMCA stenosis is proved, no additional injections of the left coronary artery are done. The right coronary artery is then studied, and the procedure is terminated. By carefully following this protocol, serious complications from the catheterization procedure have been greatly reduced. The natural history of patients with proved LMCA stenosis of greater than 50y0 reveals that they are at greatest risk in the first few weeks following coronary cineangiography [ 1, 3, 51. For this reason, urgent myocardial revascularization is advised if this natural process is to be modified downward. However, the significant operative mortality has tended to negate this trend. Operative mortality to date in such patients has been reported to be as high as 31y0 in 1972 [6]. Three other reports contain mortality figures of 11.7%, 12%, and 12.5% for the same operation [3, 5, 81. In an effort to decrease the risk of operation in our patients with LMCA stenosis, several empirical modifications of the usual operative technique have been employed. These include: (I) insertion of arterial and venous pressure monitoring catheters under local anesthesia, (2) avoiding hypotension during and following induction of anesthesia, and (3) initial revascularization of the most important coronary artery. Since these measures were instituted in 1971, no operative deaths have occurred in 43 patients who underwent elective bypass procedures for LMCA stenosis. There has been a total of 7 operative deaths in this group of 86 patients. Among the 84 patients with LMCA disease who were not in cardiac shock when bypass procedures were carried out, only 5 patients died. This is comparable PERCENT SURVIVORS 0 SURGICAL SURVIVORS EXCLUDING CARDIOGENIC SHOCK AND NONCARDIAC DEATHS X NONSURGICAL SURVIVORS - I3 CASES 0 CLEVELAND CLINIC - 37 NONSURGICAL CASES 0 COHEN ET AL - IS NONSURGICAL CASES I I I 1 I YEARS FOLLOWING CARDIAC CATHETERIZATION FIG. 4. Suruival of operated versus nonoperated patients with left main coronary artery stenosis [#I. 252 THE ANNALS OF THORACIC SURGERY
7 Aortocoronary Bypass in Left Main CA Stenosis to the overall operative mortality of 2.7Q/, for aortocoronary bypass at our institution [7]. The 38-month follow-up on patients who survived operation for LMCA stenosis has been gratifying (Fig. 4). When compared to the nonoperated patients in our group and the results in other series, it appears that a significant improvement has been achieved. We believe that the method described for detection and treatment of this lesion offers a unique opportunity to assess the value of aortocoronary bypass grafting. When low operative mortality is attainable, surgically treated patients with LMCA stenosis are shown to have considerably greater survival than those treated by any other method. References Bruschke, A. V. G., Proudfit, W. L., and Sones, F. M., Jr. Progress study of 590 consecutive nonsurgical cases of coronary disease followed 5-9 years: Arteriographic correlations. Circulation 47: 1147, Bruschke, A. V. G., Proudfit, W. L., and Sones, F. M., Jr. Progress study of 590 consecutive nonsurgical cases of coronary disease followed 5-9 years: Ventriculographic and other correlations. Circulation 47: 1154, Cohen, M. V., Cohn, P. F., Herman, M. V., and Gorlin, R. Diagnosis and prognosis of main left coronary artery obstruction. Circulation (Suppl. I):57, Favaloro, R. G., Effler, D. B., Groves, L. K., Sheldon, W. C., Shirey, E. K., and Sones, F. M., Jr. Severe segmental obstruction of the left main coronary artery and its divisions: Surgical treatment by the saphenous vein graft technique. J. Thorac. Cardiowasc. Surg. 60:469, Lavine, P., Kimbris, D., Segal, B. L., and Linhart, J. W. Left main coronary artery disease: Clinical, arteriographic and hernodynamic appraisal. Am. J. Cardiol. 30:791, Oldham, H. N., Jr., Kong, Y., Bartel, A. G., Morris, J. J., Jr., Behar, V. S., Peter, R. H., Rosati, R. A., Young, W. G., Jr., and Sabiston, D. C., Jr. Risk factors in coronary artery bypass surgery. Arch. Surg. 105:918, Thomas, C. S., Jr., Alford, W. C., Jr., Burrus, G. R., and Stoney, W. S. The decreasing risk of aortocoronary artery bypass. J. Tenn. Med. Assoc. 66:815, Zeft, H. J.,.Manley, J. C., Huston, J. H., Tector, A. C., and Johnson, W. D. Direct coronary surgery in patients with left main coronary artery stenosis. Circulation (Suppl. II):50, Addendum Subsequent to this report, an additional 17 patients with greater than 50% LMCA stenosis have undergone coronary artery bypass grafting at this institution with 1 hospital death.
Left main stem coronary artery disease
Thorax (1976), 31, 522. Left main stem coronary artery disease Retrospective review of 26 patients treated surgically or medically L. J. DAY, H. 0. VALLIN', and E. SOWTON Card.ac Department, Guy's Hospital,
More informationCoronary arteriographic study of mild angina
British HeartJournal, I975, 37, 752-756. Coronary arteriographic study of mild angina W. Walsh, A. F. Rickards, R. Balcon From the National Heart Chest Hospitals, London Chest Hospital, London The results
More informationCoronary artery surgery: indications and recent experience
Postgraditate Medical Journal (October 1978) 54, 649-657 Coronary artery surgery: indications and recent experience PATRICK S. ROBINSON M.R.C.P. B. STEPHEN JENKINS M.R.C.P. MARK V. BRAIMBRIDGE F.R.C.S.
More informationManagement during Reoperation of Aortocoronary Saphenous Vein Grafts with Minimal Atherosclerosis by Angiography
Management during Reoperation of ortocoronary Saphenous Vein Grafts with therosclerosis by ngiography William G. Marshall, Jr., M.D., Jeffrey Saffitz, M.D., and Nicholas T. Kouchoukos, M.D. STRCT The proper
More informationLeft Ventricular Wall Resection for Aneurysm and Akinesia due to Coronary Artery Disease: Fifty Consecutive Patients
Left Ventricular Wall Resection for Aneurysm and Akinesia due to Coronary Artery Disease: Fifty Consecutive Patients Armand A. Lefemine, M.D., Rajagopalan Govindarajan, M.D., K. Ramaswamy, M.D., Harrison
More informationDrs. Rottman, Salloum, Campbell, Muldowney, Hong, Bagai, Kronenberg
Rotation: or: Faculty: Coronary Care Unit (CVICU) Dr. Jeff Rottman Drs. Rottman, Salloum, Campbell, Muldowney, Hong, Bagai, Kronenberg Duty Hours: Mon Fri, 7 AM to 7 PM, weekend call shared with consult
More informationand Coronary Artery Surgery George M. Callard, M.D., John B. Flege, Jr., M.D., and Joseph C. Todd, M.D.
Combined Valvular and Coronary Artery Surgery George M. Callard, M.D., John B. Flege, Jr., M.D., and Joseph C. Todd, M.D. ABSTRACT Between July, 97, and March, 975,45 patients underwent combined valvular
More informationCompetitive Blood Flow in the- Coronary Circulation Simulating Progression of Proximal Coronary Artery Disease After Saphenous Vein Bypass Surgery*
Clin. Cardiol. 7, 179-183 (1984) @ Clinical Cardiology Publishing Co., Inc. Competitive Blood Flow in the- Coronary Circulation Simulating Progression of Proximal Coronary Artery Disease After Saphenous
More informationDistribution of Arterial Lesions Demonstrated by Selective Cinecoronary Arteriography
Distribution of Arterial Lesions Demonstrated by Selective Cinecoronary Arteriography By WILLIAM L. PROUDFIT, M.D., EARL K. SHIREY, M.D., AND F. MASON SONES, JR., M.D. SUMMARY The distribution of obstructions
More informationCoronary Atherosclerosis in Valvular Heart Disease
Coronary Atherosclerosis in Valvular Heart Disease Jerome Lacy, M.D., Robert Goodin, M.D., Daniel McMartin, M.D., Ronald Masden, M.D., and Nancy Flowers, M.D. ABSTRACT To evaluate the usefulness of routine
More informationIndications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014
Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications for cardiac catheterization Before a decision to perform an invasive procedure such
More informationSaphenous Vein Autograft Replacement
Saphenous Vein Autograft Replacement of Severe Segmental Coronary Artery Occlusion Operative Technique Rene G. Favaloro, M.D. D irect operation on the coronary artery has been performed in 180 patients
More informationCardiomyopathic syndrome due to coronary artery
British Heart Journal, 1977, 39, 733-739 Cardiomyopathic syndrome due to coronary artery disease' I. Relation to angiographic extent of coronary disease and to remote myocardial infarction HAROLD DASH,
More informationCoronary arteriography in complicated acute myocardial infarction; clinical and angiographic correlates
Coronary arteriography in complicated acute myocardial ; clinical and angiographic correlates Luis M. de la Fuente, M.D. Buenos Aires, Argentina From January 1979 to June 30, 1979, we performed coronary
More informationSurgical Management of the Preinfarction Syndrome
Surgical Management of the Preinfarction Syndrome Ernest A. Traad, M.D., Parry B. Larsen, M.D., Thomas 0. Gentsch, M.D., Arthur J. Gosselin, M.D., and Paul S. Swaye, M.D. ABSTRACT The indications for coronary
More informationResults of Reoperation
Results of Reoperation for Recurrent Angina Pectoris William I. Norwood, M.D., Lawrence H. Cohn, M.D., and John J. Collins, Jr., M.D. ABSTRACT Although a coronary bypass operation improves the quality
More informationThe MAIN-COMPARE Study
Long-Term Outcomes of Coronary Stent Implantation versus Bypass Surgery for the Treatment of Unprotected Left Main Coronary Artery Disease Revascularization for Unprotected Left MAIN Coronary Artery Stenosis:
More informationASSESSING PATIENTS FOR CORONARY ARTERY BYPASS SURGERY INTRODUCTION
THERAPEUTIC UPDATE ASSESSING PATIENTS FOR CORONARY ARTERY BYPASS SURGERY B L Chia LKATan INTRODUCTION Coronary artery disease is today one of the most important causes of deaths in our community (1). The
More informationReview of 131 Consecutive Patients Gerald F. Geisler, M.D., Maurice Adam, M.D., Ben F. Mitchel, M.D., Cary J. Lambert, M.D., and J. Peter Thiele, M.D.
Treatment of Severe Coronary Artery Disease with 5, 6, and 7 Saphenous Vein Bypasses: Review of 131 Consecutive Patients Gerald F. Geisler, M.D., Maurice Adam, M.D., Ben F. Mitchel, M.D., Cary J. Lambert,
More informationCoronary Arterial and Left Ventriculographic Findings in Patients with Double-Vessel Disease and Angina Pectoris*,t
Clin. Cardiol. 3,246-251 (1 980) 0 G. Witzstrock Publishing House, Inc. Coronary Arterial and Left Ventriculographic Findings in Patients with Double-Vessel Disease and Angina Pectoris*,t W.V.R. VIEWEG.
More informationOut-of-hospital Cardiac Arrest. Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland
Out-of-hospital Cardiac Arrest Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland Conflict of Interest I have no conflict of interest to disclose regarding this presentation.
More informationAssessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington
Assessing Cardiac Risk in Noncardiac Surgery Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Disclosure None. I have no conflicts of interest, financial or otherwise. CME
More informationUniversity of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives
University of Florida Department of Surgery CardioThoracic Surgery VA Learning Objectives This service performs coronary revascularization, valve replacement and lung cancer resections. There are 2 faculty
More informationAortocoronary Artery Graft During Early and Late Phases of Acute Myocardial Infarction
Aortocoronary Artery Graft During Early and Late Phases of Acute Myocardial Infarction Chalit Cheanvechai, M.D., Donald B. Effler, M.D., Floyd D. Loop, M.D., Laurence K. Groves, M.D., William C. Sheldon,
More informationPercutaneous Coronary Interventions Without On-site Cardiac Surgery
Percutaneous Coronary Interventions Without On-site Cardiac Surgery Hassan Al Zammar, MD,FESC Consultant & Interventional Cardiologist Head of Cardiology Department European Gaza Hospital Palestine European
More informationCoronary Occlusion During Coronary Angiography
Coronary Occlusion During Coronary Angiography By STEPHEN B. Guss, M. D., LEONARD M. ZIR, M.D., HENRY B. GARRISON, M. D., WILLARD M. DAGGETT, M. D., PETER C. BLOCK, M.D., AND ROBERT E. DINSMORE, M.D. SUMMARY
More informationComplete Proximal Occlusion of All Three Main Coronary Arteries Complicated With a Left Main Coronary Aneurysm: A Case Report
J Cardiol 2004 Nov; 44 5 : 201 205 Complete Proximal Occlusion of All Three Main Coronary Arteries Complicated With a Left Main Coronary Aneurysm: A Case Report Takatoshi Hiroshi Akira Takahiro Masayasu
More informationPercutaneous Transluminal Coronary Angioplasty: Role of the Surgeon
Percutaneous Transluminal Coronary Angioplasty: Role of the Surgeon Ellis L. Jones, M.D., Joe M. Craver, M.D., Andreas R. Griintzig, M.D., Spencer B. King, 111, M.D., John S. Douglas, M.D., David K. Bone,
More informationUniversity of Wisconsin - Madison Cardiovascular Medicine Fellowship Program UW CICU Rotation Goals and Objectives
Background: The field of critical care cardiology has evolved considerably over the past 2 decades. Contemporary critical care cardiology is increasingly focused on the management of patients with advanced
More information(For items 1-12, each question specifies mark one or mark all that apply.)
Form 121 - Report of Cardiovascular Outcome Ver. 9.2 COMMENTS -Affix label here- Member ID: - - To be completed by Physician Adjudicator Date Completed: - - (M/D/Y) Adjudicator Code: - Central Case No.:
More informationAdult Cardiac Surgery
Adult Cardiac Surgery Mahmoud ABU-ABEELEH Associate Professor Department of Surgery Division of Cardiothoracic Surgery School of Medicine University Of Jordan Adult Cardiac Surgery: Ischemic Heart Disease
More informationCommon Codes for ICD-10
Common Codes for ICD-10 Specialty: Cardiology *Always utilize more specific codes first. ABNORMALITIES OF HEART RHYTHM ICD-9-CM Codes: 427.81, 427.89, 785.0, 785.1, 785.3 R00.0 Tachycardia, unspecified
More informationVentricular Function and the Native Coronary Circulation Five Years after Myocardial Revascularhation
Ventricular Function and the Native Coronary Circulation Five Years after Myocardial Revascularhation Denis H. Tyras, M.D., Naseer Ahmad, M.D., George C. Kaiser, M.D., Hendrick B. Barner, M.D., John E.
More informationABNORMAL ORIGIN OF THE LEFT CIRCUMFLEX CORONARY ARTERY FROM THE RIGHT CORONARY ARTERY
ABNORMAL ORIGIN OF THE LEFT CIRCUMFLEX CORONARY ARTERY FROM THE RIGHT CORONARY ARTERY Antonio Fuertes, M.D.,* Mario Trivellato, M.D.,** and Jeff Z. Brooker, M.D.*** INTRODUCTION Primary anomalies of the
More informationCardiovascular Disorders Lecture 3 Coronar Artery Diseases
Cardiovascular Disorders Lecture 3 Coronar Artery Diseases By Prof. El Sayed Abdel Fattah Eid Lecturer of Internal Medicine Delta University Coronary Heart Diseases It is the leading cause of death in
More informationin Patients Having Aortic Valve Replacement John T. Santinga, M.D., Marvin M. Kirsh, M.D., Jairus D. Flora, Jr., Ph.D., and James F. Brymer, M.D.
Factors Relating to Late Sudden Death in Patients Having Aortic Valve Replacement John T. Santinga, M.D., Marvin M. Kirsh, M.D., Jairus D. Flora, Jr., Ph.D., and James F. Brymer, M.D. ABSTRACT The preoperative
More informationFurther Evaluation. Technique of Coronary Artery Bypass. of the Circular Sequential Vein Graft
Further Evaluation of the Circular Sequential Vein Graft Technique of Coronary Artery Bypass Joseph C. Cleveland, M.D., Ira M. Lebenson, M.D., Robert J. Twohey, M.D., Joseph G. Ellis, M.D., Daniel B. Nelson,
More informationCardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition
Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac
More informationSupplementary material 1. Definitions of study endpoints (extracted from the Endpoint Validation Committee Charter) 1.
Rationale, design, and baseline characteristics of the SIGNIFY trial: a randomized, double-blind, placebo-controlled trial of ivabradine in patients with stable coronary artery disease without clinical
More informationDistal Coronary Artery Dissection Following Percutaneous Transluminal Coronary Angioplasty
Distal Coronary rtery Dissection Following Percutaneous Transluminal Coronary ngioplasty Douglas. Murphy, M.D., Joseph M. Craver, M.D., and Spencer. King 111, M.D. STRCT The most common cause of acute
More informationImportance of the third arterial graft in multiple arterial grafting strategies
Research Highlight Importance of the third arterial graft in multiple arterial grafting strategies David Glineur Department of Cardiovascular Surgery, Cliniques St Luc, Bouge and the Department of Cardiovascular
More information12 th Annual West Virginia ACC Meeting April 8, 2017
12 th Annual West Virginia ACC Meeting April 8, 2017 Rameez Sayyed, M.D., FACC, FSCAI Associate professor of Medicine Program Director for interventional cardiology Marshall University Joan C. Edwards
More informationAirway Management in a Patient with Klippel-Feil Syndrome Using Extracorporeal Membrane Oxygenator
Airway Management in a Patient with Klippel-Feil Syndrome Using Extracorporeal Membrane Oxygenator Beckerman Z*, Cohen O, Adler Z, Segal D, Mishali D and Bolotin G Department of Cardiac Surgery, Rambam
More informationNoninvasive Visualization of the Left Main Coronary Artery by Cross-sectional Echocardiography
Noninvasive Visualization of the Left Main Coronary Artery by Cross-sectional Echocardiography ARTHUR E. WEYMAN, M.D., HARVEY FEIGENBAUM, M.D., JAMES C. DILLON, M.D., KENNETH W. JOHNSTON, AND REGINALD
More informationIntroduction. Study Design. Background. Operative Procedure-I
Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic
More informationRight Coronary Artery With Anomalous Origin and Slit Ostium
Right Coronary Artery With Anomalous Origin and Slit Ostium Raul Garcia Rinaldi, MO, Jorge Carballido, MO, Richard Giles, MO, Emilio Del Taro, MO, and Raul Porro, MO Departments of Cardiovascular Surgery
More informationAcute coronary insufficiency
Acute coronary insufficiency Review of 46 patients L. J. DAY, G. E. THIBAULT,' AND E. SOWTON From the Cardiac Department, Guy's Hospital, London British Heart Journal, 1977, 39, 363-370 Forty-six patients
More information2017 Cardiology Survival Guide
2017 Cardiology Survival Guide Chapter 4: Cardiac Catheterization/Percutaneous Coronary Intervention A cardiac catheterization involves a physician inserting a thin plastic tube (catheter) into an artery
More informationExtreme pulmonary hypertension caused by mitral valve disease
British Heart Journal, I975, 37, 74-78. Extreme pulmonary hypertension caused by mitral valve disease Natural history and results of surgery C. Ward and B. W. Hancock From the Cardio-Thoracic Unit, Northern
More informationSignificance of angina pectoris
British Heart Journal, 1976, 38, 811-815. Significance of angina pectoris in aortic valve stenosis A. B. Mandall and Ian R. Gray From the Department of Cardiology, Walsgrave Hospital, Coventry Of 60 patients
More informationDetailed Order Request Checklists for Cardiology
Next Generation Solutions Detailed Order Request Checklists for Cardiology 8600 West Bryn Mawr Avenue South Tower Suite 800 Chicago, IL 60631 www.aimspecialtyhealth.com Appropriate.Safe.Affordable 2018
More informationDistribution Of Grafts In Aortocoronary Bypass Surgery: Cardiovascular Surgery Fellowship Experience.
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 17 Number 1 Distribution Of Grafts In Aortocoronary Bypass Surgery: Cardiovascular Surgery Fellowship Experience. J C Eze Citation
More informationPulmonary Valve Replacement
Pulmonary Valve Replacement with Fascia Lata J. C. R. Lincoln, F.R.C.S., M. Geens, M.D., M. Schottenfeld, M.D., and D. N. Ross, F.R.C.S. ABSTRACT The purpose of this paper is to describe a technique of
More informationOutcome of elderly patients with severe but asymptomatic aortic stenosis
Outcome of elderly patients with severe but asymptomatic aortic stenosis Robert Zilberszac, Harald Gabriel, Gerald Maurer, Raphael Rosenhek Department of Cardiology Medical University of Vienna ESC Congress
More informationZachary I. Hodes, M.D., Ph.D., F.A.C.C.
Zachary I. Hodes, M.D., Ph.D., F.A.C.C. Disclamer: I personally have no financial relationship with any company mentioned today. The Care Group, LLC does have a contract with Cardium to participate in
More informationCIPG Transcatheter Aortic Valve Replacement- When Is Less, More?
CIPG 2013 Transcatheter Aortic Valve Replacement- When Is Less, More? James D. Rossen, M.D. Professor of Medicine and Neurosurgery Director, Cardiac Catheterization Laboratory and Interventional Cardiology
More informationAlfa Ferry FRCS Cardiac Surgeon OPERATIVE MANAGEMENT IN CORONARY ARTERY DISEASE
Alfa Ferry FRCS Cardiac Surgeon OPERATIVE MANAGEMENT IN CORONARY ARTERY DISEASE Management in CHD Medical (medikamentosa) Intervensi 1. Percutaneous ( PTCA & stenting ) 2. Surgical ( CABG, CABG & mitral
More informationComparison of Early and Late Mortality in Men and Women After Isolated Coronary Artery Bypass Graft Surgery in Stockholm, Sweden, 1980 to 1989
JACC Vol. 29, No. 3 March 1, 1997:659 64 659 CARDIAC SURGERY Comparison of Early and Late Mortality in Men and Women After Isolated Coronary Artery Bypass Graft Surgery in Stockholm, Sweden, 1980 to 1989
More informationCardiac Conditions in Sport & Exercise. Cardiac Conditions in Sport. USA - Sudden Cardiac Death (SCD) Dr Anita Green. Sudden Cardiac Death
Cardiac Conditions in Sport & Exercise Dr Anita Green Cardiac Conditions in Sport Sudden Cardiac Death USA - Sudden Cardiac Death (SCD)
More informationCURRENT STATUS OF STRESS TESTING JOHN HAMATY D.O.
CURRENT STATUS OF STRESS TESTING JOHN HAMATY D.O. INTRODUCTION Form of imprisonment in 1818 Edward Smith s observations TECHNIQUE Heart rate Blood pressure ECG parameters Physical appearance INDICATIONS
More informationHISTORY. Question: How do you interpret the patient s history? CHIEF COMPLAINT: Dyspnea of two days duration. PRESENT ILLNESS: 45-year-old man.
HISTORY 45-year-old man. CHIEF COMPLAINT: Dyspnea of two days duration. PRESENT ILLNESS: His dyspnea began suddenly and has been associated with orthopnea, but no chest pain. For two months he has felt
More information(Ann Thorac Surg 2008;85:845 53)
I Made Adi Parmana The utility of intraoperative TEE has become increasingly more evident as anesthesiologists, cardiologists, and surgeons continue to appreciate its potential application as an invaluable
More informationCase Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)?
Cronicon OPEN ACCESS CARDIOLOGY Case Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)? Valentin Hristov* Department of Cardiology, Specialized
More informationJournal of the American College of Cardiology Vol. 37, No. 2, by the American College of Cardiology ISSN /01/$20.
Journal of the American College of Cardiology Vol. 37, No. 2, 2001 2001 by the American College of Cardiology ISSN 0735-1097/01/$20.00 Published by Elsevier Science Inc. PII S0735-1097(00)01133-5 Coronary
More informationSetting The setting was a hospital. The economic study was carried out in Australia.
Coronary artery bypass grafting (CABG) after initially successful percutaneous transluminal coronary angioplasty (PTCA): a review of 17 years experience Barakate M S, Hemli J M, Hughes C F, Bannon P G,
More informationOptions for my no option Patients Treating Heart Conditions Via a Tiny Catheter
Options for my no option Patients Treating Heart Conditions Via a Tiny Catheter Nirat Beohar, MD Associate Professor of Medicine Director Cardiac Catheterization Laboratory, Medical Director Structural
More informationSpecific Basic Standards for Osteopathic Fellowship Training in Cardiology
Specific Basic Standards for Osteopathic Fellowship Training in Cardiology American Osteopathic Association and American College of Osteopathic Internists BOT 07/2006 Rev. BOT 03/2009 Rev. BOT 07/2011
More informationCONTEMPORARY USE OF ARTERIAL GRAFTS DURING CORONARY ARTERY BYPASS SURGERY: PARADIGM SHIFT? OR A LITTLE (MORE) TALK THAT NEEDS A LOT MORE ACTION
CONTEMPORARY USE OF ARTERIAL GRAFTS DURING CORONARY ARTERY BYPASS SURGERY: PARADIGM SHIFT? OR A LITTLE (MORE) TALK THAT NEEDS A LOT MORE ACTION JAMES L ZELLNER MD I have no financial disclosures. 1897
More informationDoes Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement?
Original Article Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement? Hiroaki Sakamoto, MD, PhD, and Yasunori Watanabe, MD, PhD Background: Recently, some articles
More informationThe Long-Term Follow-Up of Patients Undergoing Saphenous Vein Bypass Surgery
The Long-Term Follow-Up of Patients Undergoing Saphenous Vein Bypass Surgery By DAvm S. CANNOM, M.D., D. CRAIG MILLER, M.D., NORMAN E. SHUMWAY, M.D., THOMAS J. FoGARTY, M.D., PAT.0. DAILY, M.D., MAIE Hu,
More informationDR ALEXIA STAVRATI CARDIOLOGIST, DIRECTOR OF CARDIOLOGY DEPT, "G. PAPANIKOLAOU" GH, THESSALONIKI
The Impact of AF on Natural History of CAD DR ALEXIA STAVRATI CARDIOLOGIST, DIRECTOR OF CARDIOLOGY DEPT, "G. PAPANIKOLAOU" GH, THESSALONIKI CAD MOST COMMON CARDIOVASCULAR DISEASE MOST COMMON CAUSE OF DEATH
More informationIschemic Mitral Regurgitation
Ischemic Mitral Regurgitation 1 / 6 2 / 6 3 / 6 Ischemic Mitral Regurgitation Background Myocardial infarction (MI) can directly cause (IMR), which has been touted as an indicator of poor prognosis in
More informationPrognosis in Coronary Artery Disease
Prognosis in Coronary Artery Disease Angiographic, Hemodynamic, and Clinical Factors By GARY W. BURGGRAF, M.D. AND JOHN. PARKER, M.D. SUM MARY Evaluation of the results of surgery for coronary artery disease
More informationIdiopathic Hypertrophic Subaortic Stenosis and Mitral Stenosis
CASE REPORTS Idiopathic Hypertrophic Subaortic Stenosis and Mitral Stenosis Martin J. Nathan, M.D., Roman W. DeSanctis, M.D., Mortimer J. Buckley, M.D., Charles A. Sanders, M.D., and W. Gerald Austen,
More information12 Lead Electrocardiogram (ECG) PFN: SOMACL17. Terminal Learning Objective. References
12 Lead Electrocardiogram (ECG) PFN: SOMACL17 Slide 1 Terminal Learning Objective Action: Communicate knowledge of 12 Lead Electrocardiogram (ECG) Condition: Given a lecture in a classroom environment
More informationAn Expedient and Versatile Catheter for Primary STEMI Transradial Catheterization/Intervention
An Expedient and Versatile Catheter for Primary STEMI Transradial Catheterization/Intervention Jack P. Chen, MD, FACC, FSCAI, FCCP Medical Director, Northside Heart Institute, Atlanta, GA and Tak Kwan,
More informationLocal Coverage Determination (LCD) for Cardiac Catheterization (L29090)
Local Coverage Determination (LCD) for Cardiac Catheterization (L29090) Contractor Information Contractor Name First Coast Service Options, Inc. Contractor Number 09102 Contractor Type MAC - Part B LCD
More informationThe MAIN-COMPARE Registry
Long-Term Outcomes of Coronary Stent Implantation versus Bypass Surgery for the Treatment of Unprotected Left Main Coronary Artery Disease Revascularization for Unprotected Left MAIN Coronary Artery Stenosis:
More informationT ing (CABG) compared with medical therapy for coronary
Coronary Artery Bypass in Patients With Severely Depressed Ventricular Function Carmelo A. Milano, MD, William D. White, MPH, L. &chard Smith, PhD, Robert H. Jones, MD, James E. Lowe, MD, Peter K. Smith,
More informationSevere Coronary Vasospasm Complicated with Ventricular Tachycardia
Severe Coronary Vasospasm Complicated with Ventricular Tachycardia Göksel Acar, Serdar Fidan, Servet İzci and Anıl Avcı Kartal Koşuyolu High Specialty Education and Research Hospital, Cardiology Department,
More informationIschemic heart disease
Ischemic heart disease Introduction In > 90% of cases: the cause is: reduced coronary blood flow secondary to: obstructive atherosclerotic vascular disease so most of the time it is called: coronary artery
More informationCase Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA
Case Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA Case History A 50-year-old man with type 1 diabetes mellitus and hypertension presents after experiencing 1 hour of midsternal chest pain that began after
More informationWhy is co-morbidity important for cancer patients? Michael Chapman Research Programme Manager
Why is co-morbidity important for cancer patients? Michael Chapman Research Programme Manager Co-morbidity in cancer Definition:- Co-morbidity is a disease or illness affecting a cancer patient in addition
More informationPreliminary Programme
Preliminary Programme The scientific programme comprises various styles of presentations and sessions, each offering a unique opportunity to amass new and important scientific information. Optimal management
More informationin Endarteredomized Coronary Arteries
Patency and Flow Response in Endarteredomized Coronary Arteries M. Laxman Kamath, M.D., Donald H. Schmidt, M.D., Pablo M. Pedraza, M.D., Fred M. Blau, M.S., A. Sampathkumar, M.D., Linda L. Grzelak, B.S.,
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute coronary syndrome(s), anticoagulant therapy in, 706, 707 antiplatelet therapy in, 702 ß-blockers in, 703 cardiac biomarkers in,
More informationThe Relationship between P rola psing Mitral Leaflet Syndrome and Angina and Normal Coronary Arteriograms*
The Relationship between P rola psing Mitral Leaflet Syndrome and Normal Coronary Arteriograms* F. Khan Nakh;avan, M.D., F.C.C.P.; Gangaiah Natara;an, M.B., B.S.;t Paravasthu Seshachary, M.D.;:j: and Harry
More informationCardiovascular Diseases and Diabetes
Cardiovascular Diseases and Diabetes LEARNING OBJECTIVES Ø Identify the components of the cardiovascular system and the various types of cardiovascular disease Ø Discuss ways of promoting cardiovascular
More informationCase Report. Chest Pain in a Young Woman
Case Report Chest Pain in a Young Woman ROGER L. CLICK, M.D., Ph.D., JOHN A. SPITTELL, Jr., M.D., Division of Cardiovascular Diseases and Internal Medicine; FRANCISCO J. PUGA, M.D., Section of Thoracic
More informationResults of conservative treatment of angina pectoris in candidates for aortocoronary saphenous vein bypass'
British HeartJournal, I973, 35, 53I-537. Results of conservative treatment of angina pectoris in candidates for aortocoronary saphenous vein bypass' Lotfy L. Basta, J. Michael Kioschos, and Francois M.
More informationCMS Limitations Guide - Cardiovascular Services
CMS Limitations Guide - Cardiovascular Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations
More informationP F = R. Disorder of the Breast. Approach to the Patient with Chest Pain. Typical Characteristics of Angina Pectoris. Myocardial Ischemia
Disorder of the Breast Approach to the Patient with Chest Pain Anthony J. Minisi, MD Department of Internal Medicine, Division of Cardiology Virginia Commonwealth University School of Medicine William
More informationHeart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United
Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United States, totaling about 750,000 individuals annually
More informationNatural History of Ischemic Heart Disease in Relation
Natural History of Ischemic Heart Disease in Relation to Arteriographie Findings A Twelve Year Study of 224 Patients By J. O'NEAL HUMPHRIES, M.D., LEWIS KULLER, M.D., RICHARD S. Ross, M.D., GOTTLIEB C.
More informationLnformation Coverage Guidance
Lnformation Coverage Guidance Coverage Indications, Limitations, and/or Medical Necessity Abstract: B-type natriuretic peptide (BNP) is a cardiac neurohormone produced mainly in the left ventricle. It
More informationComplications of Acute Myocardial Infarction
Acute Myocardial Infarction Complications of Acute Myocardial Infarction Diagnosis and Treatment JMAJ 45(4): 149 154, 2002 Hiroshi NONOGI Director, Division of Cardiology and Emergency Medicine, National
More informationKinsing Ko, Thom de Kroon, Najim Kaoui, Bart van Putte, Nabil Saouti. St. Antonius Hospital, Nieuwegein, The Netherlands
Minimal Invasive Mitral Valve Surgery After Previous Sternotomy Without Aortic Clamping: Short- and Long Term Results of a Single Surgeon Single Institution Kinsing Ko, Thom de Kroon, Najim Kaoui, Bart
More information9/28/2011 CARDIAC CATHETERIZATION CODING DISCLAIMER AGENDA CATRENA SMITH, CCS, CCS-P, CPC, PCS. 1. Cardiac Catheterization s defined
CARDIAC CATHETERIZATION CODING CATRENA SMITH, CCS, CCS-P, CPC, PCS PRESIDENT, ACCESS QUALITY CODING & CONSULTING, LLC 1 DISCLAIMER This material is provided to assist in education for coders. Every attempt
More informationHon-Kan Yip, MD; Chiung-Jen Wu, MD; Mien-Cheng Chen, MD; Hsueh-Wen Chang, PhD; Kelvin Yuan-Kai Hsieh, MD; Chi-Ling Hang, MD; and Morgan Fu, MD
Effect of Primary Angioplasty on Total or Subtotal Left Main Occlusion* Analysis of Incidence, Clinical Features, Outcomes, and Prognostic Determinants Hon-Kan Yip, MD; Chiung-Jen Wu, MD; Mien-Cheng Chen,
More informationWHI Form Report of Cardiovascular Outcome Ver (For items 1-11, each question specifies mark one or mark all that apply.
WHI Form - Report of Cardiovascular Outcome Ver. 6. COMMENTS To be completed by Physician Adjudicator Date Completed: - - (M/D/Y) Adjudicator Code: OMB# 095-044 Exp: 4/06 -Affix label here- Clinical Center/ID:
More information