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[Coronary artery bypass grafting to total occlusion of all three coronary vessels]
M Yamada1, T Narisawa, H Kazuma
1Department of Surgery, School of Medicine, Showa University.
Insights
This study examined rare cases of complete blockage in all three coronary arteries. Coronary artery bypass grafting (CABG) led to significant recovery in these complex patients.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Studied 4,100 patients undergoing coronary arteriography between 1975-1992.
- Identified four patients (0.1%) with complete occlusion of all three coronary arteries.
Observation:
- Patients had a mean of 2.3 coronary risk factors but long-standing angina (16.3 years mean).
- All cases had prior myocardial infarction; 75% had aortic aneurysms.
- Coronary arteriography revealed total occlusion in the right, left anterior descending, and left circumflex arteries.
Findings:
- All four patients underwent coronary artery bypass grafting (CABG).
- Despite poor distal coronary tree visualization via collateral flow, significant clinical recovery was achieved post-CABG.
- Assessment of cardiac performance was limited due to severe angina (C.C.S. Grade IV).
Implications:
- Coronary artery bypass grafting (CABG) can be effective for total occlusion of all three coronary arteries.
- These findings offer insights into managing this rare and severe cardiovascular condition.
- Further research may refine treatment strategies for complex coronary artery disease.
Abstract:
We studied total occlusion of all three coronary arteries. From 1975 to 1992, a total of 4,100 patients underwent coronary arteriography at Show University Hospital. Of these, four patients (0.1%) had complete occlusion of all three coronary arteries and all of them underwent coronary artery bypass grafting (CABG). The mean numbers of coronary risk factors were only 2.3 but history of angina of effort were long-standing such as 4 to 29 years (mean 16.3 yr). All cases had previous episodes of myocardial infarction. Three cases (75%) had aortic aneurysm. One case was also diagnosed as Leriche syndrome besides coexisting aneurysm. Coronary arteriogram showed total occlusion of right coronary artery, left anterior descending artery and left circumflex artery in the segment of 1.6 or 7 and 11 respectively. All cases had intracoronary anastomosis and intercoronary anastomosis. Among 12 occluded coronary arteries of all four cases, 11 were distally visualized with contrast medium via collateral flow but good opacification of the distal coronary trees were not seen. Also proper assessments of cardiac performance including viability of myocardium were not established because all cases were in the state of C.C.S grades IV. But significant clinical recovery were obtained in all cases after CAGB of three or four bypass. We conclude that these results might be a useful suggestion for the treatment of total occlusion of all three coronary arteries.