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Unsuspected idiopathic mediastinal fibrosis complicating coronary bypass operation
I Aleksic1, F Saldaña, T Busch
1Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Göttingen, Germany. ialeksi@gwdg.de
Insights
Idiopathic mediastinal fibrosis presented a surgical challenge during coronary bypass grafting. Surgeons adapted techniques due to aortic encasement, successfully completing the procedure.
Area of Science:
- Cardiovascular Surgery
- Thoracic Pathology
Background:
- A 66-year-old female patient presented for coronary artery bypass grafting (CABG) to the left anterior descending and circumflex arteries.
- The patient had an underlying systemic inflammatory process of unknown etiology, complicating the surgical approach.
Observation:
- Intraoperative findings revealed extensive fibrotic plaques encasing the ascending aorta upon pericardial opening.
- This aortic fibrosis precluded standard aortic cannulation and proximal anastomosis for the planned vein graft.
Findings:
- The surgical team successfully performed a modified CABG procedure using the right internal mammary artery to the left anterior descending artery.
- Anastomosis to the obtuse marginal artery was achieved using the left internal mammary artery after employing femoral arterial cannulation.
- Pathological examination confirmed the presence of idiopathic mediastinal fibrosis.
Implications:
- This case highlights the critical importance of intraoperative vigilance and adaptability in managing complex cardiovascular surgical cases.
- Idiopathic mediastinal fibrosis can present significant challenges in cardiac surgery, necessitating alternative revascularization strategies.
- Successful adaptation of surgical techniques underscores the feasibility of CABG in the presence of aortic encasement.
Abstract:
A 66-year-old woman was referred for coronary bypass operation to the left anterior descending and the circumflex arteries. She had a systemic inflammatory process of unknown origin. On opening the pericardium, fibrotic plaques encircling the entire ascending aorta were found. Aortic cannulation and proximal anastomosis of the planned vein graft were impossible. The right internal mammary was anastomosed to the left anterior descending artery, the left to the obtuse marginal after femoral arterial cannulation. Pathologic examination revealed idiopathic mediastinal fibrosis.