Angiographic follow-up of myocardial revascularization using the vineberg procedure correlated with intraoperative imaging

IMAGE

Angiographic follow-up of myocardial revascularization using the vineberg procedure correlated with intraoperative imaging

José Glauco Lobo Filho; Antonio Jorge de Vasconcelos Forte; Maria Cláudia A Leitão

Instituto Dr. Glauco Lobo, Fortaleza, CE - Brazil

^{Mailing address}

Key words: Angiography; myocardial revascularization; mammary arteries.

Introduction

The Vineberg procedure comprises implantation of the internal thoracic artery (ITA), without ligating the intercostal side branches, directly into the left ventricle muscle. Over the past 8 years, we have successfully used the Vineberg technique which was modified by the senior author¹, obtaining low morbidity and mortality rates and high graft patency rates², in more than 60 patients who were unable to undergo direct myocardial revascularization with ITA anastomosis to the anterior interventricular artery (AIA). In the majority of these unusual cases, the AIA was hypoplastic, with difuse atheromatous disease, which is incompatible with an endarterectomy procedure and direct revascularization or angioplastic surgery. As per current literature, the Vineberg procedure is a last resort therapeutic option^3-5. In regard to angiogenesis, which is one of the justifications for the efficacy of the Vineberg procedure, the medical literature demonstrates the induction of angiogenesis in an ischemic human myocardium; other studies suggest a beneficial association of this procedure with angiogenic therapy^6-10. We believe that in the near future, patients will be able to profit from this powerful treatment combination.

References

1. Lobo JG Fº. Procedimento de Vineberg: proposta de uma variação técnica. Rev Bras Cir Cardiovasc. 2001;16: 66-9.

2. Lobo JG Fº, Forte AJV, Leitão MCA, Lobo HG Fº, Silva AA, Machado JJA. Vineberg’s procedure modified technique: flow analysis, immediate postoperative results and angiographic evaluation. J Card Surg. 2006; 21 (4): 370-6.

3. Quigley RL. Synergy of old and new technology results in successful revascularization of the anterior myocardium with relief of angina in the absence of suitable targets. Heart Surg Forum. 2004;7 (5): E343-8.

4. Van Langenhove G, Serrano P, Serruys PW. Vineberg revisited: long-term survival more than two decades after direct surgical myocardial revascularization. Int J Cardiol. 2000; 73 (1): 83-6.

5. Nasu M, Akasaka T, Chikusa H, Shoumura T. Flow reserve capacity of left internal thoracic artery 23 years after Vineberg procedure. Ann Thorac Surg. 1996; 61 (4): 1242-4.

6. Pecher P, Schumacher BA. Angiogenesis in ischemic human myocardium: clinical results after 3 years. Ann Thorac Surg. 2000; 69: 1414-9.

7. Johnson WD, Chekanov VS, Nikolaychik VV, Kipshidze N. Vineberg procedure combined with therapeutic angiogenesis: old wine in a new bottle. Ann Thorac Surg. 2001; 72: 1443-4.

8. Robicsek F, Fokin AA. Vineberg Operation combined with growth factor implantation. Ann Thorac Surg. 2002; 74: 973-5.

9. Fokin AA, Robicsek F, Masters TN, Dyke CM, Gordon BE. Enhancement of the Vineberg procedure by bFGF application. J Mol Cell Cardiol. 2000; 32: 142.

10. Henry TD, Annex BH, McKendall GR, Azrin MA, Lopez JJ, Giordano FJ, et al. The VIVA Trial: Vascular endothelial growth factor in ischemia for vascular angiogenesis. Circulation. 2003; 107: 1359-65.

Manuscript received March 15, 2007; revised manuscript received June 3, 2007; accepted July 12, 2007.

Publication Dates

• Publication in this collection
  18 Apr 2008
• Date of issue
  Oct 2007