Procedure
Preoperative workup and strategy
Routine preoperative workup aims to check the baseline status of systems and organs other than heart. Thus a chest x-ray to check lungs, complete blood count, renal and liver function tests are done to screen for abnormalities. Physical examination to determine the quality of the grafts or the safety of removing them, such as varicosities in the legs, or the Allen test in the arm is performed to be sure that blood supply to the arm wont be disturbed critically.Administration of anticoagulants such as aspirin, clopidogrel, ticagrelol and others, is stopped serval days before the operation, to prevent excessive bleeding during the operation and in the following period. Warfarin is also stopped for the same reason and the patient starts being administered heparin products after INR falls below 2.0.After the angiogram is reviewed by the surgical team, targets are selected (that is, which native arteries will be bypassed and where the anastomosis should be placed). Ideally, all major lesions in significant vessels should be addressed. Most commonly, left internal thoracic artery (LITA; formerly, left internal mammary artery, LIMA) is anastomosed to left anterior descending artery (LAD) because the LAD is the most significant artery of the heart, since it supplies a larger portion of myocardium than other arteries.A conduit can be used to graft one or more native arteries. In the latter case, an end-to-side anastomosis is performed. In the former, utilizing a sequential anastomosis, a graft can then deliver blood to two or more native vessels of the heart.
Because of its rather rare occurrence, Dents disease is often diagnosed as idiopathic hypercalciuria, i.e., excess calcium in urine with undetermined causes. References
External links
Genetic Hypercalciuria
Dent disease on Orphanet