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To assess the difference in hyperlipidemia between patients with bicuspid aortic valve (BAV) and those with a normal aortic valve (NAV), and to compare aortic valve stenosis (AS), with aortic valve regurgitation (AR). Among 32 patients with BAV and 142 patients with NAV who underwent aortic valve replacement, 81 patients had AR and 91 patients had AS. The preoperative clinical characteristics were compared between the BAV and NAV patients. Patients with replacement of the ascending aorta were included, and those who underwent combined valvular surgery, coronary artery bypass grafting, or statin treatment were excluded. The proportions of females patients (p = 0.42), patients with diabetes (p = 0.26) and patients on dialysis (p = 0.69) were similar in the two groups. Mean age was significantly lower, the mean diameter of the ascending aorta was significantly larger, and the rate of surgical intervention for the ascending aorta was significantly higher in the BAV group than in the NAV group (all p

Coronary artery bypass grafting (CABG) has been widely performed for coronary artery disease. Therefore, cases requiring reoperative CABG are increasing. We performed a minimally invasive direct coronary artery bypass (MIDCAB) procedure on four patients, as reoperative CABG surgery for the right coronary artery (RCA), employing the right gastroepiploic artery (RGEA). The target sites were the distal RCA in two patients and the posterior descending (PD) branch in the other two. Complete revascularization was accomplished in all patients without sternotomy, cardiopulmonary bypass (CPB), or blood transfusion. The mean operative time was 3.0 h (range: 2.4-3.7 h). Postoperative coronary angiography showed all grafts to be patent. All patients were discharged without postoperative complications and remained free from cardiac events during a mean follow-up period of 1.5 years (range: 0.5-3.0 years). MIDCAB for the RCA, employing the RGEA via a subxiphoid incision showed, excellent revascularization in redo CABG cases. This technique is a safe and effective method for redo cases.

Background: The number of reoperative (redo) coronary artery bypass grafting (CABG) for patients with long-term hemodialysis has been increasing. Off-pump CABG (OP-CAB) may decrease risks associated with redo CABG. Methods: Two patients on chronic hemodialysis with calcification of the ascending aorta underwent redo double coronary OPCAB for the left anterior descending artery (LAD) and the posterior descending artery (PDA) via median sternotomy. The LAD was bypassed with the left internal thoracic artery (LITA). The PDA was exposed with minimum dissection and bypassed with a composite graft of the right internal thoracic artery (RITA) and the saphenous vein (SV). Results: Both patients made a quick recovery with no complications and one had postoperative angiography that showed the patent grafts. Both patients were free from angina pectoris at follow-up of 6 months and 3 months, respectively. Conclusion: Redo OPCAB of the LAD and PDA can be performed with minimal dissection via median sternotomy using the LITA and a composite graft of the RITA and SV.

Between January 1987 and October 1992, 11 neonates and 2 infants (12 males and 1 female) underwent arterial switch operation (ASO). There were 9 simple transpositions of great arteries (TGA), 3 TGA with ventricular septal defect (VSD), and 1 double outlet of right ventricle (Taussig-Bing) with TGA. There were 12 cases of patent ductus arteriosus (PDA) and 6 cases of atrial septal defect (ASD). Nine patients had Yacoub type A coronary pattern, 3 had type B, and 1 had type D. The neonates' mean age was 15.5 days (one 120 days old and one 22 months old). The average body weight of the neonates was 4.2 kg. The Lecompte maneuver was performed on all patients. The average bypass time was 187.8 min, and mean aortic cross-clamp time was 76.2 min, with a mean circulatory arrest time of 10 min in 6 cases. Early hospital mortality was 15.4% (2 deaths)—1 patient died during operation from myocardial infarction, and another died postoperatively from poor heart function. All survivors experienced early postoperative heart failure and needed temporary inotropic support. One patient was lost to follow-up. The other 10 patients were free from any cardiac symptoms at follow-up, with good left ventricular function. Mild to moderate aortic regurgitation and stenosis and the same in the pulmonary valve were seen on echocardiogram. Seventeen months after ASO, 1 patient required reoperation for severe postoperative pulmonary stenosis. We concluded that ASO can be performed with an acceptable mortality rate in a new unit with no previous experience of such surgery.

An 8-year-old girl with Kawasaki disease underwent surgical revascularization to the left anterior descending coronary artery on the beating heart via a left anterior short thoracotomy. Angiography 21 months after surgery showed excellent graft patency. This case--the first success in minimally invasive surgical coronary artery revascularization in a child in the world--suggests that minimally invasive methods are a reasonable alternative in coronary artery revascularization in a child with Kawasaki disease whose left anterior descending artery is the only requiring it.

A 28-year-old male with total occlusion of the main trunk of the left coronary artery underwent successful coronary artery bypass surgery with bilateral internal mammary arteries. He did not have hypercholesterolemia and the ascending aorta, bilateral internal mammary arteries, and peripheral part of the left coronary artery were normal in character and size, which indicated that no systemic or inflammatory diseases caused the lesion. Smoking was the only risk factor identified.

A 52-year-old male patient with left main trunk disease and absent right coronary artery underwent successful coronary artery bypass grafting with in situ arterial conduits. Bilateral internal mammary arteries and the gastroepiploic artery were employed, with the inferior epigastric artery as a composite graft to the left internal mammary artery. The postoperative angiogram showed excellent patency of all 4 grafts and cardiac performance during exercise monitored by scintigram was found to be satisfactory.

In 308 right gastroepiploic artery (GEA) grafting procedures performed for myocardial revascularization, 38 GEA, 34 in situ, and four free grafts were used to bypass the left anterior descending coronary artery (LAD). Indications for using the GEA for the purpose of LAD bypass were: unavailability of the internal thoracic artery (ITA) at reoperation, surgical damage to the ITA at the time of the operation, or an apparently better free flow versus that in the left ITA, particularly in patients with diabetes meltitus in whom it was considered inadvisable to use bilateral ITAs. There were 21 male and 17 female patients with a mean age of 62 years (range, 31 to 77 years). Ten patients had undergone a previous myocardial revascularization. The mean number of distal anastomoses was 2.8 (range, 1 to 5). Concomitantly used conduits were the ITA in 27 patients, saphenous veins in 21 patients, the inferior epigastricartery in 4 patients, and the bovine internal thoracic artery in 1 patient. All but 1 patient survived. Follow-up ranged from 3 to 84 months (mean, 27 months). Postoperative angiography was performed in 33 patients. At the short-term evaluation (mean, 1 month), 32 of 33 (97%) GEA grafts were found to be patent; all 4 GEA grafts studied at the long-term evaluation (mean, 25 months) were also found to be patent. In no patients did angina recur postoperatively. In 25 patients who underwent an exercise study postoperatively, the stress test results were negative in 23. In the 2 patients whose stress test results were positive, this was due to stenosis of the large diagonal artery and stenosis of the saphenous vein graft to the circumflex artery. We conclude that the GEA is a suitable conduit for LAD revascularization when the ITA is unavailable.

A technique is described for side-to-side anastomosis as a functional end-to-side anastomosis, in which no direct contact with the vessel walls by surgical instruments is required during suturing, thus avoiding the possibility of damage to the graft.