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[Operation of coronary artery aneurysm after previous coronary artery bypass grafting]
T Hiranaka1, F Nomura, K Kurozumi
1Department of Cardiovascular Surgery, Kinan General Hospital, Wkayama, Japan.
Insights
A patient with prior coronary artery bypass grafting experienced chest pain due to a circumflex artery aneurysm. Surgical ligation and internal mammary artery grafting successfully resolved symptoms, with excellent long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- Graft failure and complications can occur years after initial surgery.
- Aneurysms in coronary arteries are rare but serious complications.
Observation:
- A 43-year-old male presented with exertional chest pain 11 years post-CABG.
- Coronary angiography revealed severe stenosis and a large aneurysm in the obtuse marginal branch.
- Previous bypass grafts remained patent.
Findings:
- Surgical ligation of the aneurysm and internal mammary artery (IMA) grafting were performed via left anterolateral thoracotomy.
- The surgical approach facilitated access and minimized bleeding.
- Postoperative angiography confirmed aneurysm obstruction and a patent IMA graft.
Implications:
- This case highlights a successful surgical strategy for managing coronary artery aneurysms post-CABG.
- Minimally invasive approaches can be effective for complex coronary artery reconstructions.
- Long-term patency of IMA grafts and symptom relief were achieved.
Abstract:
A 43-year-old male, who had undergone coronary artery bypass grafting 11 years ago, developed exertional chest pain. Selective coronary angiograms revealed severe stenosis and a large aneurysm in the obtuse marginal branch of the circumflex coronary artery. Previous grafts to the left anterior descending coronary artery and diagonal branch were patent. Ligation of the aneurysm and internal mammary artery grafting were performed through a left anterolateral thoracotomy. This approach made it easy to reach the aneurysm and to minimize bleeding during dissecting the adhesions. The patient had an uncomplicated postoperative course, and postoperative coronary angiograms revealed an obstructed aneurysm and a patient internal mammary artery graft. He has done well without recurrence of symptoms.