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Internal Mammary Artery (internal + mammary_artery)

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Medical Sciences	100%

Selected Abstracts

THERMAL PRECONDITIONING PROTECTS THE HUMAN INTERNAL MAMMARY ARTERY FROM HYPOXIA/RE-OXYGENATION-INDUCED DAMAGE

CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 7 2006
Angelika Hammerer-Lercher
SUMMARY 1Preconditioning has been demonstrated to ameliorate ischaemia/reperfusion injury in several cells and tissues. Therefore, in the present study we investigated whether preconditioning of human bypass grafts, internal mammary artery (IMA) and saphenous vein (SV) induces heat shock protein (Hsp) expression and reduces apoptosis in response to subsequent hypoxia/re-oxygenation damage in both vessels. 2Internal mammary artery and SV rings, obtained from 30 patients (median age 66.5 years) undergoing coronary artery bypass grafting, were either incubated for 30 min at 42°C (preconditioned) or kept in a standard incubator at 37°C (not preconditioned). Six hours later, graft segments were exposed to 90 min hypoxia followed by a 30 min re-oxygenation period. Western blot, real-time quantative polymerase chain reaction analysis and apoptosis detection by the Terminal deoxyribonucleotidyl transferase-mediated dUTP,digoxigenin nick end-labelling method were performed. 3Heat-preconditioned IMA showed significantly increased protein expression of Hsp72 after hypoxia/re-oxygenation treatment compared with controls (median 9.1 vs 5.0 µg/mg total protein; P = 0.048). Expression of Hsp73 was weak and Hsp60 was not detectable in the IMA. 4In the SV, neither protein nor mRNA expression of Hsp were significantly different between preconditioned and not preconditioned veins. 5There were significantly fewer apoptotic cells in the intima of the preconditioned compared with not preconditioned IMA (P = 0.041) after hypoxia/re-oxygenation injury, whereas in the SV apoptosis was not significantly prevented by preconditioning. 6Mild heat preconditioning before hypoxia/re-oxygenation injury is a stimulus for Hsp72 protein expression and a reduction in apoptosis in the human IMA. [source]

Left Internal Mammary Artery (LIMA) Flow Reserve in Ischemic Hypertrophied Hearts

JOURNAL OF CARDIAC SURGERY, Issue 1 2009
Tomas A. Salerno M.D.
We, herein, present clinical evidence suggesting that in ischemic hypertrophied hearts, single arterial inflow from the LIMA to multiple grafts based on the LIMA may not be sufficient and may not meet myocardial demands, at least during the early perioperative period. This observation was made in two patients in whom a vein graft, previously based on the LIMA, was also connected to the aorta. By providing additional inflow from the aorta, flows to the LAD significantly increased. [source]

Beyond peripheral arteries in Buerger's disease: Angiographic considerations in thromboangiitis obliterans

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2002
Bobbi Hoppe MD
Abstract Thromboangiitis obliterans is an inflammatory peripheral vascular disease that is strongly associated with smoking. It predominantly affects distal small- and medium-sized blood vessels of both the upper and lower extremities. We present histological evidence of this disease process affecting the internal mammary arteries. This can be of paramount clinical significance for patients with Buerger's disease who present with obstructive coronary artery disease and require coronary artery bypass grafting surgery (CABG). Internal mammary arteries involved with thromboangiitis obliterans cannot be utilized as arterial conduits during CABG and other alternatives have to be used. Therefore, we recommend preoperative angiography of both internal mammary arteries in patients with Buerger's disease requiring CABG to prevent extensive intraoperative dissection of diseased internal mammary arteries. Cathet Cardiovasc Intervent 2002;57:363,366. © 2002 Wiley-Liss, Inc. [source]

Effects of Delaying Fluid Resuscitation on an Injury to the Systemic Arterial Vasculature

ACADEMIC EMERGENCY MEDICINE, Issue 4 2002
James F. Holmes MD
Abstract. Objectives: To determine the effects of delaying fluid on the rate of hemorrhage and hemodynamic parameters in an injury involving the arterial system. Methods: Twenty-one adult, anesthetized sheep underwent left anterior thoracotomy and transection of the left internal mammary artery. A chest tube was inserted into the thoracic cavity to provide a continuous measurement of blood loss. The animals were randomly assigned to one of three resuscitation protocols: 1) no fluid resuscitation (NR), 2) standard fluid resuscitation (SR) begun 15 minutes after injury, or 3) delayed fluid resuscitation (DR) begun 30 minutes after injury. All of the animals in the two resuscitation groups received 60 mL/kg of lactated Ringer's solution over 30 minutes. Blood loss and hemodynamic parameters were measured throughout the experiment. Results: Total hemorrhage volume (mean ± SD) at the end of the experiment was significantly lower (p = 0.006) in the NR group (1,499 ± 311 mL) than in the SR group (3,435 ± 721 mL) or the DR group (2,839 ± 1549 mL). Rate of hemorrhage followed changes in mean arterial pressure in all groups. Hemorrhage spontaneously ceased significantly sooner (p = 0.007) in the NR group (21 ± 14 minutes) and the DR group (20 ± 15 minutes) than in the SR group (54 ± 4 minutes). In the DR group, after initial cessation of hemorrhage, hemorrhage recurred in five of six animals (83%) with initiation of fluid resuscitation. Maximum oxygen (O2) delivery in each group after injury was as follows: 101 ± 34 mL O2/kg/min at 45 minutes in the DR group, 51 ± 20 mL O2/kg/min at 30 minutes in the SR group, and 35 ± 8 mL O2/kg/min at 60 minutes in the NR group. Conclusions: Rates of hemorrhage from an arterial injury are related to changes in mean arterial pressure. In this animal model, early aggressive fluid resuscitation in penetrating thoracic trauma exacerbates total hemorrhage volume. Despite resumption of hemorrhage from the site of injury, delaying fluid resuscitation results in the best hemodynamic parameters. [source]

Total Autologous Ross Procedure in a Child With Aortic Root Abscess

JOURNAL OF CARDIAC SURGERY, Issue 5 2006
Yusuf Kenan Yalcinbas M.D.
Methods: An 8-year-old girl was presented with dyspnea, high fever, and fatigue. She had stenotic bicuspid aortic valve with endocarditis and aortic root abscess. Ross procedure was performed with fresh autologous pericardial tube and pericardial monocusp valve. Right internal mammary artery to right coronary artery bypass was also done due to destructed right coronary artery ostium. Results: Four years after the operation she is in excellent clinical condition without medications. Echocardiography reveals mild autograft regurgitation and mildly stenotic right ventricular outflow tract. Conclusions: If homografts are not available, total reconstruction of RVOT with autologous fresh pericardium may offer reasonable early and mid-term results especially when active endocarditis and aortic root abscess is involved. [source]

Robotic Surgery Using ZeusÔ MicroWristÔ Technology

JOURNAL OF CARDIAC SURGERY, Issue 1 2003
The Next Generation
Methods: We used the ZeusÔ (Computer Motion Inc., Goleta, Calif, USA) telemanipulation system to perform the internal mammary artery (IMA) takedown in 56 patients, in 12 of whom we used the newest model with MicroWristÔ (Computer Motion Inc., Goleta, Calif, USA) technology. Port orientation was based on thoracic anatomy, the decisive landmarks being the mammillary line and the axillary line. The distance between ports was at least 9 cm, and the patient's arm was positioned with the left shoulder raised and angulated by not more than 90 degrees. Results: Mean setup time was 44 ± 18 minutes for the first five patients and 16 ± 7 minutes for the last five patients, with an overall average of 24 ± 12 minutes. IMA harvest time at the beginning reached a mean of 95 ± 23 minutes and decreased to 44 ± 18 minutes in the last five cases. Average IMA takedown time was 58 ± 17 minutes. The IMA was patent with a good flow in all 56 patients. Conclusions: The introduction of robotic technology into clinical routine has resulted in safe procedures with a short learning curve. However, basic training in the modality is a must in order to achieve technical excellence. (J Card Surg 2003; 18:1-5) [source]

A Xiphoid Approach for Minimally Invasive Coronary Artery Bypass Surgery

JOURNAL OF CARDIAC SURGERY, Issue 4 2000
Federico Benetti M.D.
However, opening the pleura has been a limitation of using these approaches. Aim: We used the xiphoid approach as an alternative to opening the pleura and to minimize pain after minimally invasive coronary artery bypass surgery. Methods: We review our surgical experience in 55 patients who underwent minimally invasive direct coronary artery bypass (MIDCAB) surgery through a xiphoid approach between October 1997 and August 1999. Thoracoscopy (n = 31) or direct vision (n = 24) were used for internal mammary artery (IMA) harvesting. Mean patient age was 67 ± 10 years and 65% were men. The mean Parsonnet score was 23 ± 10. Performed anastomoses included left IMA (LIMA) to the left anterior descending (LAD) artery (n = 53), LIMA-to-LAD and saphenous vein graft from the LIMA to the right coronary artery (n = 1), and LIMA-to-LAD and right IMA (RIMA) to right coronary artery (n = 1). Results: Postoperative complications included atrial fibrillation (12%), acute noninfectious pericarditis (12%), and acute renal failure (5%). Mean postoperative length of stay was 4 ± 2 days. Angiography was performed in 16 patients and demonstrated excellent patency of the anastomoses. There was no operative mortality. Actuarial survival was 98% in a mean follow-up period of 11 ± 5 months. Conclusions: Minimally invasive coronary artery bypass can be performed safely through a xiphoid approach with low morbidity, mortality, and a relatively short hospital stay. [source]

Thrombin generation in vascular tissue

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 1 2006
A. PATHAK
Summary.,Background: Classically, it is thought that the vast majority of thrombin is generated on the surface of platelets, however, thrombotic events occur in patients despite treatment with potent antiplatelet agents. Methods and results: In freshly harvested left internal mammary artery (IMA) sections, addition of CaCl2 and platelet-poor plasma (PPP) were sufficient to stimulate a profound burst of thrombin and this effect was inhibited by antitissue factor antibodies. Ultracentrifugation of PPP to remove platelet microparticles had no effect on thrombin generation. Both the extrinsic and factor VIII-dependent pathways were necessary for IMA-supported thrombin generation as PPP derived from individuals deficient in factors V, VII, VIII or X did not support thrombin production. Small amounts of thrombin were generated utilizing factor IX (FIX)-deficient plasma, however, thrombin was not generated by aorta from FIX-deficient mice when FIX-deficient plasma was used. The addition of non-lipidated tissue factor (0.6 pm) and CaCl2 to actively proliferating cultured human aortic smooth muscle cells (SMC) resulted in a pronounced burst of thrombin generation occurring between 3 and 15 min after treatment. In the absence of tissue factor, thrombin was generated but at a slower rate and with a peak value 26% of that observed in the presence of tissue factor. Conclusion: Significant thrombin generation can occur on vascular tissue in the absence of platelets or platelet microparticles and on the surface of non-apoptotic SMC. [source]

Can chronic poststernotomy pain after cardiac valve replacement be reduced using thoracic epidural analgesia?

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2004
M. K. Jensen
Background:, The aim of our study was to evaluate the use of thoracic epidural analgesia (TEA) in acute pain management after cardiac valve replacement and determine if the incidence of chronic pain related to the sternotomy was reduced by the use of TEA. This patient group was chosen to exclude pain related to the use of the internal mammary artery and angina pectoris. Methods:, Patients scheduled for elective cardiac valve replacement were offered TEA. A match-control group was selected. Epidural catheter placement, complications and postoperative neurological state were noted for both groups. Eighteen months postoperatively, a questionnaire was sent out concerning pain management, wound discomfort and pain. Results:, Forty-nine patients were included. The TEA group consisted of 35 patients. At 18 months' follow up, 37% from the TEA group and 21% from the control group had pain or discomfort related to the sternum (NS). Two in the TEA group had severe pain. Conclusion:, We found in our small material that TEA provided excellent analgesia in the peri- and postoperative period, but we did not find a protective effect of TEA on chronic poststernotomy pain, neither weak pain nor severe pain. [source]

Life Threatening Hemorrhage From Osteoradionecrosis of the Ribs and Clavicle

THE LARYNGOSCOPE, Issue 9 2007
MRCS, Mohammed Iqbal Syed MD
Osteoradionecrosis (ORN) is a familiar complication of radiotherapy. ORN of the clavicle and ribs is well documented after radiation therapy for breast and pulmonary malignancy. ORN of the clavicle after radiation therapy to the neck is very rare. We report the first case in which both clavicles and first ribs underwent ORN 14 years after neck irradiation and surgery for laryngeal malignancy. The presentation was atypical; erosion of the right internal mammary artery causing life-threatening hemorrhage. Otolaryngologists should be aware that ORN can occur at an unusual site and can have an atypical presentation. [source]

Effects of potassium channel opener KRN4884 on human conduit arteries used as coronary bypass grafts

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2000
Zhen Ren
Aims The effects of a new potassium channel opener KRN4884 on human arteries have not been studied. This study was designed to investigate the effects of KRN4884 on the human internal mammary artery (IMA) in order to provide information on possible clinical applications of KRN4884 for preventing and relieving vasospasm of arterial grafts in coronary artery bypass grafting. Methods IMA segments (n = 140) taken from patients undergoing coronary surgery were studied in the organ chamber. Concentration-relaxation curves for KRN4884 were established in the IMA precontracted with noradrenaline (NA), 5-hydroxytryptamine (5-HT), angiotensin II (ANG II), and endothelin-1 (ET-1). The effect of glibenclamide (GBC) on the KRN4884-induced relaxation was also examined in NA or 5-HT-precontracted IMA. Concentration-contraction curves for the four vasoconstrictors were constructed without/with pretreatment of KNR4884 (1 or 30 µm) for 15 min. Results KRN4884 induced less relaxation (P < 0.05) in the precontraction induced by ET-1 (72.9 ± 5.5%) than by ANG II (94.2 ± 3.2%) or NA (93.7 ± 4.1%) with lower EC50 (P < 0.05) for ANG II (,8.54 ± 0.54 log m) than that for NA (,6.14 ± 0.15 log M) or ET-1 (,6.69 ± 0.34 log m). The relaxation in the IMA pretreated with GBC was less than that in control (P < 0.05). KRN4884-pretreatment significantly reduced the contraction (P < 0.05) induced by NA (151.3 ± 18.4% vs 82.7 ± 8.7%), 5-HT (82.7 ± 12.2% vs 30.1 ± 7.3%), and ANG II (24.3 ± 6.3% vs 5.4 ± 1.6%), but did not significantly reduce the contraction induced by ET-1 (P > 0.05). Conclusion KRN4884 has marked vasorelaxant effects on the human IMA contracted by a variety of vasoconstrictors and the effect is vasoconstrictor-selective. [source]

Vasoconstrictor activity of novel endothelin peptide, ET-1(1 , 31), in human mammary and coronary arteries in vitro

BRITISH JOURNAL OF PHARMACOLOGY, Issue 6 2001
Janet J Maguire
The ability of the putative chymase product of big endothelin-1 (big ET-1), ET-1(1 , 31), to constrict isolated endothelium-denuded preparations of human coronary and internal mammary artery was determined. pD2 values in coronary and mammary artery respectively were 8.21±0.12 (n=14) and 8.55±0.11 (n=12) for ET-1, 6.74±0.11 (n=16) and 7.10±0.08 (n=16) for ET-1(1 , 31) and 6.92±0.10 (n=15) and 7.23±0.11 (n=12) for big ET-1. ET-1(1 , 31) was significantly less potent than ET-1 (P<0.001, Student's t -test) and equipotent with big ET-1. Vasoconstrictor responses to 100 , 700 nM ET-1(1 , 31) were significantly (P<0.05, Student's paired t -test) attenuated by the ETA antagonist PD156707 (100 nM). There was no effect of the ECE inhibitor PD159790 (30 ,M), the ECE/NEP inhibitor phosphoramidon (100 ,M) or the serine protease inhibitor chymostatin (100 ,M) on ET-1(1 , 31) responses in either artery. Radioimmunoassay detected significant levels of mature ET in the bathing medium of coronary (1.6±0.5 nM, n=14) and mammary (2.1±0.6 nM, n=14) arteries, suggesting that conversion of ET-1(1 , 31) to ET-1 contributed to the observed vasoconstriction. ET-1(1 , 31) competed for specific [125I]-ET-1 binding to ETA and ETB receptors in human left ventricle with a pooled KD of 71.6±7.0 nM (n=3). Therefore, in human arteries the novel peptide ET-1(1 , 31) mediated vasoconstriction via activation of the ETA receptor. The conversion of ET-1(1 , 31) to ET-1, by an as yet unidentified protease, must contribute wholly or partly to the observed constrictor response. Chymase generated ET-1(1 , 31) may therefore represent an alternative precursor for ET-1 production in the human vasculature. British Journal of Pharmacology (2001) 134, 1360,1366; doi:10.1038/sj.bjp.0704384 [source]

Coronary steal syndrome with coil embolization of a large LIMA side branch: Radionuclide evidence for reversible ischemia

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2005
Nasser Abdo MD
Abstract This case presents the controversy over coronary artery steal syndrome following bypass surgery when a large branch of the left internal mammary artery (LIMA) is not ligated. A discussion of previous attempts to understand the physiology of this anatomy is compared with case reports of objective evidence for ischemia that resolves following occlusion of the LIMA side branch. © 2005 Wiley-Liss, Inc. [source]

Septic embolism to the right internal mammary artery causing acute myocardial infarction

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2004
Christophe L. Dubois MD
No abstract is available for this article. [source]

Crush stenting of bifurcational left subclavian-vertebral artery stenosis

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2004
Ariel Roguin MD
Abstract Left internal mammary artery (LIMA) has the best long-term patency in patients undergoing coronary artery bypass surgery. Stenosis of the proximal left subclavian artery (SA) may reduce flow to the LIMA, causing myocardial ischemia. We report a novel technique (crush stenting) for the treatment of a complex bifurcational left SA-vertebral artery (VA) stenosis in the presence of a patent LIMA bypass conduit. This technique limited plaque shifting, restored normal flow to all vessels, including the LIMA, and avoided devastating consequences of VA occlusion. Catheter Cardiovasc Interv 2004;62:393,395. © 2004 Wiley-Liss, Inc. [source]