Coronary-coronary free internal thoracic artery graft on a single, distal, left anterior descending artery lesion.
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Adult↗
Biomedical subjects
Predrag Milojević
Publications and source records attributed to Predrag Milojević.
[Strategies for endoscopic and surgical treatment of biliary tract calculi].
INTRODUCTION: Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitits. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. CLASSIFICATION: From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs, 2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. DISCUSSION: Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. CONCLUSION: Common bile duct calculi represent a common disease of the digestive system. Endoscopic diagnostic procedure is very important in management of choledocholithiasis. Endoscopic treatment of common bile duct calculi prior to cholecystectomy is a method of choice and a strategy for associated cholecysto-choledocholithiasis.
Cholelithiasis↗
Off-pump myocardial revascularization using the Octopus tissue stabilizer system.
Off-pump coronary artery bypass surgery (OPCAB) has changed the approach to contemporary coronary surgery. Development of new surgical devices and techniques has reduced morbidity and mortality during off-pump surgery. From March 2000-April 2002, a total of 136 patients underwent open heart surgery using off-pump technique and fast-track anesthesia at Dedinje Cardiovascular Institute. Octopus Medtronic coronary stabilizer was used for stabilization of targeted vessel. Arterial grafts were used 169 times and saphenous vein 69 times. Average number of anastomoses was 1,830,73 per patient. One patient (0.74%) died. Three patients (2.21%) underwent surgery revision due to postoperative bleeding and one (0.74%) because of graft dysfunction. Perioperative myocardial infarction was registered 2 times (1.47%), pneumothorax 3 times (2.21%), postoperative arrhythmias 11 times (8.09%), transitory ischemic attack once (0.74%) and deep wound infection once (0.74%). Twelve patients (8.82%) required prolonged inotropic support. Angiographies early revealed patent grafts in 8 patients (5.88%). OPCAB is a safe and effective alternative approach to coronary artery revascularization. Use of coronary stabilizer has improved the safety and quality of OPCAB surgery.
Cardiopulmonary Bypass↗
[High thoracic epidural anesthesia in coronary surgery].
INTRODUCTION: High thoracic epidural anesthesia and analgesia are being increasingly used for coronary artery bypass graft surgery. The reasons for this include excellent perioperative pain control with advantage of early tracheal extubation, improved postoperative pulmonary function, and cardiac protection due to sympthatetic blockade. EFFECTS OF HIGH THORACIC EPIDURAL ANESTHESIA: Cardiac protection is the consequence of decreased heart rate, myocardial contractility and arterial blood pressure, without changes in coronary perfusion pressure. Therefore, high thoracic epidural analgesia beneficially alters major determinants of myocardial oxygen consumption, without jeopardizing coronary perfusion pressure. In addition, decrease of functional residual capacity, may reduce postoperative pulmonary morbidity. RESULTS OF CLINICAL STUDIES: Patients with high thoracic epidural anesthesia revealed a more favourable perioperative hemodynamic profile, lower incidence of ischemia and better response to perioperative stress. HIGH THORACIC EPIDURAL ANESTHESIA TECHNIQUE: The epidural catheter should be placed at the Th2/Th3 interspace at least one hour before administration of heparin. After local anesthetic bolus dose, a continuous epidural infusion is recommended. CONCLUSION: There is strong evidence for beneficial effects of high thoracic epidural anesthesia in patients undergoing surgical myocardial revascularization. However, it is still underutilized in current clinical practice.
Anesthesia, Epidural↗
[Role of intravenous cholangio-cholecystography in the diagnosis of asymptomatic choledocholithiasis].
INTRODUCTION: Standard diagnostic procedures (anamnesis, physical examination, laboratory analyses, ultrasound diagnosis), commonly used in diagnosis and preparation for surgical intervention of patients with cholelithiasis, are in most cases a reliable indicator for evaluation of the disease and conditions planned for surgery. DISCUSSION: In some cases by application of these narrow diagnostic models, some conditions, anatomic variations and biliary tract malformations remain unrecognized. Asymptomatic ("silent") choledocholithiasis (2.02%) represents a special diagnostic and therapeutic problem. CONCLUSION: Our extended diagnostic protocol includes routine intravenous cholangio-cholecystography as a standard diagnostic procedure for evaluation of cholecysto-choledocholithiasis prior planning cholecystectomy.
Cholangiography↗
[In situ pedicle graft and coronary-coronary bypass grafting using internal thoracic artery in management of multiple lesions of the left anterior descending coronary artery].
INTRODUCTION: Nowadays, coronary-coronary bypass grafting (CCBG) has been applied in patients with heavily calcified ascending aorta or due to lack of graft material. CASE REPORT: We describe a case in which the patient's large left anterior descending (LAD) coronary artery, running well over the cardiac apex, presented with proximal and distal stenosis. Although the pedicled left internal thoracic artery (ITA) graft is sometimes too short for sequential bypass in cases of distal stenosis of the LAD coronary artery, we used a free, short segment of the pedicled left ITA for coronary-coronary bypass grafting. The in situ remnant of the left pedicled ITA was used to bypass the proximal LAD stenosis. The patient's postoperative course was uneventful. Predischarge angiogram (on the 9th postoperative day) showed an in situ left ITA graft as well as afree coronarycoronary ITA graft. The patient had a regularfollow-up after 3 months, and was classified as New York Heart Association (NYHA) class I. DISCUSSION: Primarily used in aorto-coronary bypass surgery (termino-terminal interposition of the saphenous vein between two parts of a resected coronary artery), CCBG was revised latter on, and from hemodynamic point of view the physiologic restoration of coronary blood flow has been confirmed CCBG might be an attractive approach for bypassing distal lesions of large coronary arteries (combined with arterial or venous grafting of targeted arteries, if proximal stenoses are also present). The proximal remnant of ITA can be used as an in situ or free graft.
Coronary Artery Bypass↗