Life-threatening ventricular arrhythmias and pulseless electrical activity due to coronary artery spasm may lead to aborted sudden cardiac death (ASCD). Implantable cardioverter-defibrillator (ICD) had been implanted in majority of these patients. In the previous reports, just a quarter of these patients had appropriate ICD shocks during the follow-up periods of 41 ± 28 months. Although sufficient medications including multiple vasodilators were the first line therapy, less medication were frequently observed in patients with ASCD due to coronary artery spasm in the clinic. One-quarter patients with ASCD due to coronary artery spasm after the implantation of ICD had appropriate ICD shocks under the medications during the follow-up periods, whereas the remaining three-quarter patients had no appropriate ICD shocks. If cardiologists performed the sequential spasm provocation tests under the sufficient medications in ASCD patients due to pure coronary spasm as one of option for the ICD implantation, we may classify these ASCD patients for the requirement of ICD implantation to suppress the next life-threatening ventricular arrhythmias in the future.

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Objective: The saphenous vein (SV) is a commonly used graft; however, sometimes, it cannot be used due to small diameter or abnormal morphology. Although ultrasonography has been widely used to evaluate SV preoperatively, it has difficulty in capturing the entire image of the SV. We conducted this study to clarify the usefulness of noncontrast computed tomography (CT) and to elucidate the incidence of inadequate SV as a graft. Materials and methods: All patients routinely underwent preoperative thoracoabdominal CT. The scanning range was extended to the ankles and the exposure increased by approximately 5–6 mGy. Three-dimensional (3D) CT images were reconstructed from noncontrast CT images. From October 2017 to February 2019, 54 patients' SVs were evaluated by preoperative 3D-CT. We generally harvested the SV from the lower leg, but if the SV of the lower leg had any morphological abnormality, we harvested from the thigh. Results: Of the 54 patients, the proportion of patient with inadequate SVs was approximately 20%. Adequate SV was 76.9% in the lower legs and 88.0% in the thighs. Forty-seven SVs were harvested from the lower legs, and 15 SVs were switched to harvest from the thighs. The average diameter of harvested SV grafts was 3.8 mm in the thigh and 3.7 mm in the lower leg. Conclusion: Noncontrast 3D-CT can provide accurate, objective, and reproducible high-resolution images of the SVs with a slight increase in radiation exposure. The proportion of adequate SV was not high, and nearly 40% of the patients had an inadequate SV as a graft.

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Objective: Cardiopulmonary bypass offers a stable hemodynamic condition during coronary bypass surgery, but undesirable side-effects emerge as complicating issues. We developed a minimally invasive cardiopulmonary bypass modifying extracorporeal membrane oxygenation to alleviate the side-effects of conventional cardiopulmonary bypass. Herein, we evaluated the effectiveness of the modified extracorporeal membrane oxygenation in coronary bypass surgery. Materials and methods: 79 patients who underwent coronary bypass surgery using cardiopulmonary bypass between January 2014 and March 2019 were divided into those using conventional cardiopulmonary bypass (n=47) and those using the modified extracorporeal membrane oxygenation (n=32). We compared the results of these groups. Results: The operation time in the patients with the modified extracorporeal membrane oxygenation were significantly shorter than those with conventional cardiopulmonary bypass (p =0.001). Heparin and priming volume were less required for the modified extracorporeal membrane oxygenation. The in-hospital mortality and morbidity were comparable between the groups. However, the length of intubation and intensive care unit stay following the operation with the modified extracorporeal membrane oxygenation were significantly shorter than those with conventional cardiopulmonary bypass (p =0.018 and p =0.001, respectively). Furthermore, the creatinine kinase MB isozyme value at the end of the operation with the modified extracorporeal membrane oxygenation was significantly lower than that with conventional cardiopulmonary bypass (p =0.002). Conclusion: Our modified extracorporeal membrane oxygenation seemed less invasive than conventional cardiopulmonary bypass because of the reduced operation time and the early postoperative recovery. This system is beneficial when performing coronary bypass surgery, especially for high-risk patients.

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Coronary-bronchial artery fistula is an unusual coronary anomaly, whose management is controversial because of the great variability in its natural history. Here, we describe a case of coronary-bronchial artery fistula that caused hemoptysis. She was a 75-year-old woman also having multiple coronary-pulmonary artery fistulae with saccular aneurysmal changes who was successfully treated via surgery. Open surgical repair is effective in patients with multiple fistulae and aneurysms. In the case described here, multidetector computed tomography was useful for making an accurate diagnosis of coronary-bronchial artery fistula.

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A patient with chest pain and inferoseptal ischemia at Rubidium-82 Positron Emission Tomography (⁸²RbPET) was revascularized in a stenosis in the LAD/D1 bifurcation, while a CTO RCA was left untreated. One-year follow-up with Seattle Angina Questionnaire and repeat ⁸²RbPET revealed symptom relief and improved inferoseptal perfusion likely through LAD collateralization.

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