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[Coronary Artery Bypass Grafting complicated with sternocostoclavicular hyperostosis;Report of a Case]
Kazutaka Horiuchi1, Syunsuke Nakata, Satsuki Komoda
1Department of Cardiovascular Surgery, Okazaki City Hospital, Okazaki, Japan.
Insights
This case report highlights sternocostoclavicular hyperostosis, a rare condition complicating cardiac surgery. Early recognition is crucial for managing surgical risks and postoperative complications like osteomyelitis.
Area of Science:
- Cardiovascular Surgery
- Radiology
- Rheumatology
Background:
- A 72-year-old male with multiple comorbidities including myocardial infarction, diabetes, dyslipidemia, hypertension, and COPD presented for cardiac surgery.
- The patient had congestive heart failure, multi-vessel coronary artery disease, and moderate aortic valve stenosis and regurgitation.
Observation:
- Intraoperative findings revealed severe adhesions and tissue fibrosis around the sternum, complicating dissection.
- Injury to the left internal thoracic artery (LITA) occurred during dissection, necessitating a great saphenous vein graft to the left anterior descending artery.
Findings:
- Computed tomography (CT) diagnosed sternocostoclavicular hyperostosis, characterized by a thickened sternum and sternoclavicular joint adhesion.
- Postoperative complications included osteomyelitis and necrosis of the left side skin incision, requiring omentopexy.
Implications:
- Sternocostoclavicular hyperostosis is a rare but significant condition that requires preoperative evaluation in cardiac surgery patients.
- Recognition of this condition can help anticipate surgical challenges and potential postoperative complications, improving patient management.
Abstract:
The patient was 72-year-old man, who had old myocardial infarction, diabetes mellitus, dyslipidemia, hypertension and chronic obstructive pulmonary disease. He was complicated with congestive heart failure, and multi-vessel coronary artery disease and moderate aortic valve stenosis and regurgitation were diagnosed. We performed coronary artery bypass grafting(CABG) and aortic valve replacement. Intraoperative findings showed severe adhesions and tissue fibrosis around sternum. It was very difficult to dissect adhesions around left internal thoracic artery (LITA). LITA was injured, and great saphenous vein was anastomosed to left anterior descending coronary artery. Sternocostoclavicular hyperostosis was diagnosed on computed tomography( CT) findings such as remarkably thickened ster-num and adhesion of sternoclavicular joint. Postoperative course was complicated by osteomyelysis and necrosis of left side skin incision, for which omentopexy was needed. Sternocostoclavicular hyperostosis is rare disease, but we should recognize in preoperative evaluation.
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