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Left upper lobectomy after CABG with the left internal mammary artery graft
Seri Singhatanadgige1, Wacharin Sindhvanada, Chanapong Kittayarak
1Division of Cardiothoracic Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
Performing a left upper lobectomy after a patient received a Left Internal Mammary Artery (LIMA) graft for Coronary Artery Bypass Graft (CABG) surgery presents challenges due to adhesions. This case highlights a successful surgical outcome achieved through meticulous pre-operative planning.
Area of Science:
- Cardiothoracic Surgery
- Vascular Surgery
- Oncology
Background:
- Left upper lobectomy is a complex procedure, particularly in patients with prior Coronary Artery Bypass Graft (CABG) surgery involving the Left Internal Mammary Artery (LIMA) graft.
- Adhesions in the thoracic cavity, especially around the LIMA graft, can significantly increase surgical difficulty and risk.
Observation:
- A case involving a patient requiring left upper lobectomy with a history of LIMA graft for CABG is presented.
- The primary concern was the potential for LIMA graft injury during dissection, which could lead to acute myocardial ischemia or cardiac arrest.
Findings:
- The surgical team successfully performed the left upper lobectomy.
- The successful outcome was attributed to a comprehensive pre-operative surgical and anesthetic plan.
Implications:
- This case underscores the importance of detailed pre-operative assessment and planning for complex thoracic surgeries in patients with cardiac surgical history.
- Effective planning can mitigate risks associated with adhesions and vital graft preservation, ensuring patient safety and successful surgical outcomes.
Abstract:
Left upper lobectomy in a patient with a history of Left Internal Mammary Artery (LIMA) graft for Coronary Artery Bypass Graft surgery (CABG) is a challenge for the surgical team. The adhesion formation in the left chest, especially around the left internal mammary artery graft, may cause diffculty for surgery. The injury of LIMA during dissection may lead to serious acute myocardial ischemia and cardiac arrest. The authors reported a case of successful operation after receiving both good surgical and anesthetic plan prior to surgery.
