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[A successful case of minimally invasive direct coronary artery bypass (MIDCAB) followed by PTCA]
T Nishina1, K Matsuda, S Nomoto
1Department of Cardiovascular Surgery, Kyoto University School of Medicine, Japan.
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) using the internal thoracic artery (ITA) effectively treated left anterior descending (LAD) artery occlusion. This approach, combined with percutaneous transluminal coronary angioplasty (PTCA), shows promise for multivessel coronary disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Minimally Invasive Cardiac Procedures
Background:
- A 70-year-old male presented with angina pectoris, indicating significant coronary artery disease.
- Cardiac catheterization revealed critical stenosis in the left anterior descending (LAD), right coronary artery (RCA), and circumflex (CX) arteries.
Observation:
- The LAD occlusion received collateral flow from the RCA, suggesting potential for revascularization.
- A surgical plan was made for MIDCAB grafting of the LAD using the internal thoracic artery (ITA), followed by PTCA for the RCA.
Findings:
- A successful MIDCAB procedure was performed on the LAD without cardiopulmonary bypass, utilizing a left anterior submammarian incision and direct ITA harvesting.
- Postoperative recovery was rapid, and the ITA-LAD graft was confirmed patent.
- The patient subsequently underwent successful PTCA for the RCA stenosis on the 8th postoperative day.
Implications:
- MIDCAB surgery, in conjunction with subsequent PTCA, is a viable treatment option for patients with multivessel coronary artery disease.
- This combined approach may offer an effective strategy for revascularization in complex coronary artery disease scenarios.
Abstract:
A 70-year-old man who developed angina pectoris underwent cardiac catheterization, which showed total occlusion of the left anterior descending coronary artery (LAD), associated with 75% stenosis of the right coronary artery (RCA) and 90% stenosis of the small circumflex coronary artery (CX). The LAD received good collateral flow from the RCA. The patient was scheduled to undergo the MIDCAB for the LAD using the internal thoracic artery (ITA), combined with percutaneous transluminal coronary angioplasty (PTCA) for the RCA subsequently. A left anterior submammarian skin incision of 10 cm in length was made. The fifth costal cartilage was removed. The left ITA was directly harvested from the chest wall from the 4th to 7th intercostal space, and was anastomosed to the midportion of the LAD without cardiopulmonary bypass. The patient was quickly recovered after the operation. On the 8th postoperative day, the patient successfully underwent the PTCA for the RCA after the ITA-LAD graft had been verified to be patent. The MIDCAB could be indicated for multivessel coronary disease in conjunction with the PTCA.