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[Simultaneous operations for both the repair of the aortic arch aneurysm and repeated CABG]
Insights
A 73-year-old female underwent successful surgical repair for a thoracic aortic aneurysm and a blocked coronary artery. The patient recovered well, remaining asymptomatic six months post-operation.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aneurysm Repair
- Coronary Artery Bypass Grafting
Background:
- A 73-year-old female presented with thoracic pain and a history of coronary artery bypass grafting (CABG).
- Imaging revealed a 5 cm saccular aortic aneurysm distal to the left subclavian artery.
- Coronary arteriography showed a patent left circumflex graft but critical stenosis of the left anterior descending artery.
Observation:
- The patient underwent a second median sternotomy for surgical intervention.
- Coronary artery bypass grafting to the left anterior descending artery was performed using a saphenous vein graft.
- The aortic aneurysm was replaced with a prosthetic graft under deep hypothermia and selective cerebral perfusion.
Findings:
- The combined surgical procedure for aortic aneurysm and coronary artery bypass grafting was completed without intraoperative complications.
- Postoperative recovery was satisfactory, with transient atelectasis and a small thoracic hematoma resolving.
- The patient was discharged after one month and remained asymptomatic at six months follow-up.
Implications:
- This case highlights the successful management of concurrent complex cardiovascular pathologies.
- Simultaneous repair of thoracic aortic aneurysms and coronary artery disease is feasible and effective.
- Aggressive surgical management can lead to favorable long-term outcomes in elderly patients with extensive cardiovascular disease.
Abstract:
A 73-year-old female complaining of left thoracic pain was referred to our hospital. In 1988, she had the first CABG of the left circumflex coronary artery (CX) and right coronary artery. On admission in April 1994, chest X-ray and CT scan revealed a saccular aortic aneurysm, 5 x 5 cm in size, extending to the distal to the left subclavian artery. Coronary arteriography showed a patency of the CX graft, but 99% stenosis of the proximal left anterior descending branch (LAD) with delayed opacification. After the repeated median sternotomy, cardiac arrest was achieved with the aortic cross clamping and St. Thomas Hospital solution infusion. CABG to the LAD branch using a saphenous vein was accomplished. Following this, the replacement of the aortic aneurysmal lesion with a prosthetic graft was performed under the selective cerebral perfusion with deep hypothermia. Proximal anastomosis of the vein graft was completed during a rewarming period. The operation was performed without complications. Postoperative course was satisfactory except a few minor transient complications such as athelectasis of the left upper lobe and the intra-thoracic hematoma. After one month's hospitalization, she was discharged, and currently (six months postoperative) remains asymptomatic.