[Off-pump coronary artery bypass grafting and left ventricular aneurysm resection--a case report]
Piotr Hendzel1, Leszek Gryszko, Wojciech Szczawiński
1Wojskowy Instytut Medyczny, Kliniczny Oddziatu Kardiochirurgii Kliniki Kardiologii CSK MON, Warszawie.
Insights
This study details a successful off-pump coronary artery bypass (OPCAB) and left ventricular aneurysm resection (LVAn) in a patient with severe coronary heart disease. The procedure involved complex anastomoses and aneurysm resection on a beating heart without complications.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery
Background:
- A 55-year-old patient presented with advanced coronary heart disease (CCS Class III) post-myocardial infarction.
- Coronarography identified severe (90%) occlusion in three left coronary artery branches.
- Ventriculography revealed a dyskinetic left ventricular aneurysm of the apex and anterior wall.
Observation:
- The patient was deemed suitable for off-pump coronary artery bypass (OPCAB) and left ventricular aneurysm resection (LVAn).
- Surgical procedures were performed on a beating heart using an Octopus II stabilizer.
- Distal anastomoses were created to the marginal and circumflex branches, and the left internal thoracic artery was connected to the left anterior descending branch.
Findings:
- Aneurysm closure was achieved using mattress sutures on Teflon pads.
- The left ventricular aneurysm was subsequently resected and closed with continuous sutures.
- The patient experienced no operative or post-operative complications.
Implications:
- This case demonstrates the feasibility and safety of combined OPCAB and LVAn in complex coronary artery disease.
- Beating-heart surgery techniques can be effectively applied to aneurysm resection.
- Successful surgical management can improve outcomes for patients with severe left ventricular dysfunction and coronary artery disease.
Abstract:
We present the case of a 55-year-old patient with coronary heart disease of class III of the Canadian Cardiovascular Society (CCS), after cardiac antero-lateral wall infarction at unknown time. Coronarography revealed 90% occlusion of three branches of left coronary artery. Ventriculography showed dyskinetic aneurysm of apex and anterior wall without presence of thrombus. On the basis of the performed examination the patient was qualified to off-pump coronary artery bypass (OPCAB) and left ventricular aneurysm resection (LVAn). On the beating heart with the use of Octopus II stabilizer distal (side to side) anastomosis was performed to marginal branch and (end to side) to circumflex as a jump graft. Subsequently left internal thoracic artery to left anterior descending branch anastomosis was performed. And then, on the beating heart on the two Teflon pads entry of aneurysm was closed by the mattress sutures. Next the aneurysm was resected and closed with additional continuous suture. There were non operative and post-operative complications.
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