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[Coronary artery bypass grafting for ischemic heart disease combined with aortitis]
T Isomura1, K Hisatomi, T Nakao
1Second Department of Surgery, Kurume University School of Medicine.
Insights
Coronary artery bypass grafting (CABG) in a patient with aortitis required careful preoperative assessment. Saphenous vein grafts were used due to non-viable internal thoracic arteries and gastroepiploic artery.
Area of Science:
- Cardiovascular Surgery
- Vascular Imaging
- Aortitis Management
Background:
- A 67-year-old female patient with a history of right radical mastectomy presented for coronary artery bypass grafting (CABG).
- Preoperative evaluation revealed diffuse stenotic lesions in both the right and left coronary arteries.
- A significant pressure gradient (90 mmHg) between the ascending aorta and radial artery suggested hypertension secondary to distal aortic stenosis.
Observation:
- Coronary angiography demonstrated diffuse stenotic lesions in both coronary arteries.
- Aortography revealed occluded bilateral internal thoracic arteries (ITAs) and stenotic abdominal aorta.
- The cephalic artery was supplied via a dilated gastroepiploic artery (GEA), rendering it unsuitable for CABG.
Findings:
- Quadruple CABG was successfully performed using mild varicose saphenous vein grafts.
- Grafts included left anterior descending artery, its third branch, and sequential grafts to the right posterior descending and atrioventricular branches.
- The patient's aortitis complicated graft selection, necessitating alternative arterial sources.
Implications:
- Preoperative imaging to assess arterial lesions, particularly in the internal thoracic arteries (ITAs) and gastroepiploic artery (GEA), is crucial in patients with aortitis undergoing CABG.
- This case highlights the importance of thorough vascular assessment to identify suitable grafts when standard arterial conduits are compromised.
- Alternative grafting strategies, such as utilizing saphenous vein grafts, are vital for successful revascularization in complex aortitis cases.
Abstract:
Coronary artery bypass grafting (CABG) was performed in a 67-year-old woman with aortitis. She had a past history of right radical mastectomy. Preoperative coronary angiogram showed diffuse stenotic lesions in both right and left coronary arteries. The pressure gradient between ascending aorta and peripheral radial artery was 90 mmHg and the cause of coronary stenosis seemed to be hypertension due to stenotic distal aorta. The aortogram showed occluded bilateral internal thoracic arteries (ITA) and stenotic abdominal aorta. The cephalic artery was supplied by a large meandering artery via dilated gastroepiploic artery (GEA). And thus the GEA was not useful for CABG. Quadruple CABG was performed with mild varicose saphenous vein (saphenous vein grafts to left anterior descending artery and third branch, and sequential saphenous vein graft to right posterior descending and atrioventricular branches). It seemed to be important to demonstrate the arterial lesion of ITA and GEA before CABG in patients with aortitis.