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Transsternal bilateral thoracotomy for pericardiectomy after coronary artery bypass grafting
T Harada1, K Nakayama, T Kitano
1Department of Cardiovascular Surgery, Shimane Prefectural Central Hospital, Japan.
Insights
Transsternal bilateral thoracotomy offers a safe surgical approach for constrictive pericarditis after coronary artery bypass grafting. This technique avoids injury to bypass grafts, enabling complete pericardiectomy without cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Constrictive pericarditis is a rare but challenging complication following cardiac surgery.
- Patients may have undergone coronary artery bypass grafting (CABG) with arterial and venous grafts.
- The presence of a patent left internal thoracic artery (LITA) graft poses unique surgical difficulties.
Observation:
- A 45-year-old male developed constrictive pericarditis 12 months post-CABG.
- The patient's LITA and vein grafts were situated beneath the sternum.
- Median sternotomy risked injury to these critical bypass grafts.
Findings:
- A transsternal bilateral thoracotomy provided excellent surgical exposure of the heart.
- Complete pericardiectomy was successfully performed.
- The procedure was completed safely without the need for cardiopulmonary bypass.
Implications:
- Transsternal bilateral thoracotomy is a viable and safe alternative when median sternotomy is contraindicated in patients with constrictive pericarditis.
- This approach mitigates the risk of injury to underlying bypass grafts, particularly the LITA graft.
- It facilitates complete pericardiectomy in complex post-cardiac surgery scenarios.
Abstract:
Surgery for constrictive pericarditis was conducted through a transsternal bilateral thoracotomy in a 45-year-old man who developed the condition 12 months after coronary artery bypass grafting with left internal thoracic artery and vein grafts. The grafts ran just beneath the sternum. To avoid injury to the bypass grafts during sternotomy and mediastinal dissection, we conducted a transsternal bilateral thoracotomy, which provided excellent exposure of the heart. Complete pericardiectomy was done safely without cardiopulmonary bypass. Constrictive pericarditis following cardiac surgery is an uncommon complication posing difficult problems for the surgeon. The presence of a patent left internal thoracic artery bypass is particularly challenging. Transsternal bilateral thoracotomy is a useful approach in patients with constrictive pericarditis in whom a median sternotomy is contraindicated.