The cerebral circulation and metabolism of ten preoperative cardiac surgery patients were assessed. Alterations in regional cerebral blood flow (rCBF), measured by 123I-N-isopropyl-p-iodo-amphetamine single-photon emission computed tomography, and in cerebral oxygen metabolism, simultaneously detected by near-infrared spectroscopy (NIRS) before and after acetazolamide administration, were investigated. The rCBF (ml/min/100 g) increased significantly from 40.21±7.65 to 56.24±13.69(p<0.001), and a significant increase in oxyhemoglobin (Oxy-Hb) of 13.9% (p=0.0022) and total hemoglobin (Total-Hb) of 5.7% (0.0047) along with a significant decrease in deoxyhemoglobin (Deoxy-Hb) of 8.9% (p=0.0414) were observed concomitantly. Thus, the Oxy-Hb/Total-Hb ratio (%Oxy-Hb) rose significantly from 67.26±9.82% to 72.98±8.09%(p=0.0022). Examination of the relationships between individual parameters showed that the percentage changes in rCBF and Oxy-Hb were significantly correlated (r=0.758,p=0.011). The percentage changes in rCBF and %Oxy-Hb were also correlated significantly (r=0.740,p=0.014). In conclusion, this evidence suggested that NIRS is able to detect relative changes in cerebral hemodynamics and reflect luxury perfusion induced by acetazolamide. © 1999 Society of Photo-Optical Instrumentation Engineers.
ercutaneous transluminal coronary angioplasty (PTCA) occasionally causes the unexpected adverse effect of a coronary artery aneurysm, which is prone to rupture and thrombose and therefore requires repair. 1 With the increasing use of new devices, and newer ones appearing in quick succession, an increase in the frequency of this complication is expected. We describe here 2 cases of coronary artery aneurysm after PTCA, and their successful surgical repair. Case Reports Case 1A 60-year-old man developed severe post-infarction angina in December 1992. Coronary angiography (CAG) revealed 99% stenosis of the proximal left anterior descending coronary artery (LAD) and PTCA was performed, after which the residual stenosis was 50%. The patient was subsequently asymptomatic. However, the follow-up CAG after 1 month showed a small coronary artery aneurysm at the site of the previous PTCA. In April 1993, chest pain recurred and CAG showed an enlarging aneurysm and 75% restenosis of LAD and a new 75% stenosis of the distal circumflex coronary artery (CX) (Fig1). Coronary artery bypass grafting (CABG) and surgical repair of the aneurysm were therefore indicated.Surgery was performed in May 1993. The aneurysm was not visible on the heart surface, so we used a 0.5-mm angioscope (Olympus Optical Co, Ltd, Japan) to determine the site of the aneurysm. The angioscope was inserted through a small hole in the distal LAD, but, actually, little helpful information on the aneurysm was obtained through direct vision because of the scope's small caliber. The aneurysmal region of the proximal LAD, which was covered with thick epicardial fat, was identified and exposed through the guidance of the optic fiber light and the angiographical finding.The aneurysm was dissected longitudinally and plicated after removal of the mural thrombus. In addition, double CABG to the initial hole in the distal LAD with the left internal mammary artery and to the CX with the saphenous vein was performed.The postoperative course was uneventful and CAG at 1 month after the operation showed that the aneurysm had disappeared and both grafts were patent (Fig 1). We were not able to distinguish pseudoaneurysm from a true one histopathologically from the surgical specimen. Case 2A 76-year-old man was admitted because of chest pain in October 1999. CAG showed an occlusion of the proximal LAD, and an ACS Multi-Link stent (3.0×15 mm) was implanted after PTCA. The target lesion had no residual stenosis, but the follow-up CAG 4 months after the first intervention showed restenosis at the distal site of the stent. A second PTCA using a cutting balloon (3.0×15 mm) was performed and extravasation of the contrast media was demonstrated at that time. Inflation of another balloon prevented further leakage, and the patient was discharged without subsequent complication. In May 2000, chest pain recurred and CAG demonstrated a 9.0×5.0 mm coronary artery aneurysm and restenosis at the proximal site of the stent (Fig 2). Therefore, revascularization and surgical repair of the ane...
The case of a 41-year-old man who developed an aneurysm in his aberrant left subclavian artery is described. The patient had a right aortic arch. After a successful aortosubclavian artery bypass, symptoms due to brain ischemia disappeared. This is a very rare disease that is sometimes associated with an aortic anomaly, therefore the optimal therapeutic procedure need to be carefully selected, including the operative indications and approach.
The case of a 41-year-old man who developed an aneurysm in his aberrant left subclavian artery is described. The patient had a right aortic arch. After a successful aortosubclavian artery bypass, symptoms due to brain ischemia disappeared. This is a very rare disease that is sometimes associated with an aortic anomaly, therefore the optimal therapeutic procedure need to be carefully selected, including the operative indications and approach.
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