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At least 613 records · Page 34Linked to original sources
PubMedDate not supplied

Novel use of a magnetic coupling device to repair damage of the internal thoracic artery.

At present, there is limited reported literature on the use of the magnetic anastomotic device Ventrica MVP in the coronary artery bypass surgery setting. The device has been primarily used to perform distal coronary anastomoses. We report for the first time the novel use of this magnetic coupling device as a technique to repair iatrogenic injury of the left internal thoracic artery conduit. Technical issues, advantages, disadvantages, and the use of computer tomography angiogram for assessment of the anastomosis are discussed.

Constriction↗
PubMed1986

The potential of magnetic resonance imaging for the evaluation of thoracic arterial diseases.

Fifty-three patients with a variety of thoracic aortic or pulmonary arterial diseases were evaluated by magnetic resonance imaging to determine the potential of this new technique for the diagnosis of thoracic vascular disease. Direct visualization of the atherosclerotic plaques and demonstration of their precise location and extent was achieved by magnetic resonance imaging. The size and extent of the aneurysms and the presence of mural thrombus were demonstrated by magnetic resonance imaging. Magnetic resonance imaging identified the intimal flap and indicated the proximal extent of thoracic aortic dissection. Magnetic resonance imaging permitted direct visualization of thrombi and aneurysm of the pulmonary arteries. In conclusion, magnetic resonance imaging appears to be a totally noninvasive and reliable technique for demonstration of various pathologic processes involving the thoracic aorta and pulmonary arteries. Vascular imaging is achieved without the need for contrast media.

Adolescent↗
PubMed2006

Effects of C-reactive protein and cholesterol on responsiveness in vitro of the internal thoracic artery to angiotensin II in patients having coronary artery bypass grafting.

The renin-angiotensin system is critically involved in the pathogenesis of atherosclerosis. Cholesterol increases vascular responsiveness to angiotensin II by upregulation of the angiotensin II type 1 receptor. However, the effects of C-reactive protein (CRP) on vascular responsiveness to angiotensin II are unknown. We evaluated, in vitro, the vascular responsiveness of the internal thoracic artery to angiotensin II in patients who underwent coronary bypass grafting. We observed that increased preoperative CRP and increased cholesterol levels were strongly related to increased vascular responsiveness to angiotensin II (p <0.001 for the 2 comparisons). However, angiotensin II-mediated contraction was increased only when levels of CRP and cholesterol were jointly increased. In conclusion, our results suggest that CRP and cholesterol act synergistically on vascular responsiveness to angiotensin II.

Angina Pectoris↗
PubMed1996

[Endothelin-stimulated proliferation of thoracic artery smooth muscle cells involves activation of mitogen-activated protein kinase].

Endothelin (ET) is a potent vasoconstrictor whose responses are mediated through a common G-protein coupled receptor. So far little is known concerning its potential mitogenic capacity. In the present study, experiments were conducted to determine the role of mitogen-activated protein kinase (MAPK) activation in the rabbit thoracic artery smooth muscle cells (VSMC) in response to stimulation by ET-1. It was found that ET-1 produced concentration- and time-dependent increases in 3H-TdR incorporation and in MAPK activity of these cells. All the increases were inhibited by protein kinase C (PKC) inhibitors, such as Staurosporine (STP) and H-7 and by ETA receptor antagonist BQ123, but not by specific tyrosine kinase inhibitor Herbimycin A (Herb). Pre-treatment with PKC activator PMA (phorbol myristate acetate) for 24 h (PKC downregulation) significantly attenuated ET-1-induced MAPK activation. These results indicate that: (1) ET-1-stimulated proliferation of VSMC involves the activation of MAPK and (2) ET-1-induced MAPK activation is mediated through ETA receptor and PKC.

Animals↗
PubMed2004

The right internal thoracic artery and right gastroepiploic artery: alternative sites for proximal anastomosis in patients with atherosclerotic calcified aorta.

BACKGROUND: Atherosclerotic or calcified ascending aorta is an important predictor of adverse cerebrovascular events. Using off-pump coronary artery bypass (OPCAB) with composite and in situ arterial grafting to avoid aortic manipulation and clamping may reduce the risk of stroke related to aortic atheroembolism. When the aorta is calcified and cannot serve as a safe site for proximal anastomosis, this anastomosis can be performed on the proximal segment of the right internal thoracic artery (ITA) and right gastroepiploic artery (RGEA). Four such cases are described. METHODS: In 2 patients, the proximal right ITA was used as the site for proximal saphenous vein graft (SVG) anastomosis. Chronic obstructive lung disease in one patient and insulin-dependent diabetes in the other precluded performance of OPCAB with bilateral ITA. In addition, positive Allen test precluded performance of composite T-graft with radial artery (RA) on ITA. Both SVGs were anastomosed distally to the posterior descending artery. In 2 other patients, RA was connected end-to-side to the proximal segment of the RGEA. Both of these patients had repeat operations. The distal end of the RGEA was too small, and concerns regarding the future flow to a very large coronary bed precluded its use as an in situ graft. RESULTS: All patients underwent the operative procedures without any neurological or cardiovascular adverse effects, and all are midterm, symptom-free survivors. Postoperative graft patency was confirmed intraoperatively with flow measurements and postoperatively with control angiography or coronary imaging computed tomography. CONCLUSIONS: The RITA and proximal RGEA can serve safely as sites for proximal anastomosis in patients with atherosclerotic calcified aorta undergoing OPCAB.

Anastomosis, Surgical↗
PubMed1999

Use of a retractor designed to harvest an internal thoracic artery graft during cardiac surgery for patients with a unilateral lung.

Adequate exposure of the heart is required for safe cardiac surgery. We performed open heart surgery for 2 patients with a unilateral lung. In one patient, coronary artery bypass grafting was performed 13 years after left pneumonectomy for lung cancer. Mitral valve replacement was performed in the other patient whose left lung was entirely collapsed due to tuberculosis. The heart was markedly deviated to the left in both patients. A retractor designed to harvest the internal thoracic artery was very useful to obtain a good operative view of the heart. The operations were uncomplicated, and postoperative recovery was uneventful in both patients.

Aged↗
PubMed2006

PAF-receptor is preferentially expressed in a distinct synthetic phenotype of smooth muscle cells cloned from human internal thoracic artery: functional implications in cell migration.

Platelet-activating-Factor (PAF) and its structural analogues formed upon low density lipoprotein oxidation are involved in atherosclerotic plaque formation and may signal through PAF-receptor (PAF-R) expressed in human macrophages and in certain smooth muscle cells (SMCs) in the media, but rarely in the intima of human plaques. Our aim was to determine which SMC phenotype expresses PAF-R and whether this receptor is functional in cell migration. Circulating SMC progenitors and two phenotypically distinct clones of proliferative, epithelioid phenotype vs contractile, spindle-shaped SMCs from the media of adult internal thoracic artery were studied for the presence of PAF-receptor (PAF-R). The levels of specific mRNA were obtained by reverse transcription/real-time PCR, the protein expression was deduced from immunohistochemistry staining, and the functional transmigration assay was performed by Boyden chamber-type chemotaxis assay. Only SMCs of spindle-shape and synthetic phenotype expressed both mRNA and PAF-R protein and in the functional test migrated at low concentrations of PAF. Two unrelated, specific PAF-R antagonists inhibited PAF-induced migration, but did not modify the migration initiated by PDGF. The presence of functional PAF-R in arterial spindle-shaped SMCs of synthetic phenotype may be important for their migration from the media into the intima and atherosclerotic plaques formation.

Cell Movement↗
PubMed2002

[Sternal re-entry using the retractor for harvesting internal thoracic artery].

The number of redo cardiac operations, especially coronary artery bypass grafting (CABG), has recently been increasing mainly due to the failure of saphenous vein grafts. Re-opening a median sternotomy is troublesome, because of possible adhesion of the heart to the sternum. Preoperative computed tomography is quite useful and helpful in determining the degree of the adhesion of the heart and ascending aorta to the back of the sternum. We report here a safe and useful technique for sternal re-entry using a retractor for harvesting the internal thoracic artery (ITA). When re-opening a median sternotomy the incision is made to the sternal wires; the wires are then cut and removed. Small rake retractors, which are connected to the ITA retractor, are hooked to both ends of the left side of the sternum. The ITA retractor is gently wound up to lift up the sternum. An oscillating saw is then applied to divide the anterior table of the sternum. When the posterior table of the sternum is carefully divided, the left side of the sternum is automatically elevated slightly. Complete division of the sternum can be confirmed by this slight elevation. If the left side of the sternum is elevated a little bit more by the ITA retractor, the dissection of the adhesion between the sternum and the heart can be performed without assistance. This technique is most beneficial for a case of redo CABG with the use of the left ITA, but it can be applied in any patients who previously underwent median sternotomy.

Coronary Artery Bypass↗
PubMed1998

Anatomic bases of aorto-coronary bypasses: the internal thoracic artery and blood supply of the sternum.

The internal thoracic a. is much used in cardiac surgery because of its anatomic position, but its mobilisation may lead to devascularisation of the sternum. The aim of this study was to establish a precise systematisation of the vascularisation of the sternum by means of dissections and radiography after injection of contrast medium in 15 subjects. It is based on the internal thoracic a. and its collaterals, which form multiple anastomoses. This anatomic basis provides an understanding of the problems of the devascularisation (partial and temporary) and the infections that may occur following the use of one or both internal thoracic aa. during coronary bypass operations. However, it should always be regarded as the graft of choice, given the longevity of these bypasses.

Angiography↗
PubMed1989

[Dopplerography and ultrasonic scanning of the internal thoracic artery and of mammary-coronary shunts].

The study was performed in 22 patients with ischemic heart disease who underwent direct myocardial revascularization. The functional and structural state of mammary arteries was estimated by the noninvasive Duplex scanning before surgical operation to evaluate the possibility of using them as mammary-coronary bypasses (MCB). Direct blood velocity measurements in the bypasses during aortocoronary bypass (ACB) surgery and MCB were made by ultrasound pulsed Doppler system with a 10 MHz transducer. A method was developed for noninvasive Duplex scanning and evaluation of coronary bypass flow in the postoperative period by using the ultrasound system with 5 a MHz phased array linear transducer, which enabled one to obtain the bypass image in B-mode and the Doppler velocity spectrum inside the bypass.

Adult↗