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Emergency coronary artery bypass grafting after left coronary artery rupture: a case report
I Yamagishi1, T Sakurada, T Sato
1Department of Cardiovascular Surgery, Akita Medical Center, 6-17 Senshu Kubotamachi, Akita 010-0874, Japan.
Insights
Coronary artery rupture during angioplasty required emergency surgery for repair and revascularization. Successful left internal thoracic artery bypass ensured blood flow, highlighting a critical intervention for this rare complication.
Area of Science:
- Cardiology
- Interventional Cardiology
- Surgical Cardiology
Background:
- Coronary artery rupture is a known complication of percutaneous coronary interventions.
- Prompt diagnosis and management are crucial for patient outcomes.
Observation:
- A 67-year-old male experienced coronary artery rupture during balloon angioplasty of the left anterior descending artery (LAD).
- Initial management included pericardial drainage, but subsequent angiography confirmed persistent contrast leakage.
Findings:
- Emergency surgery was performed for hemostasis and revascularization of the LAD using the left internal thoracic artery (LITA).
- Epicardial hemorrhage was managed with oxidized cellulose and fibrin glue.
- Postoperative angiography showed an aneurysm of the LAD and successful LITA-LAD bypass grafting.
Implications:
- This case underscores the importance of surgical preparedness for managing acute coronary artery rupture.
- Successful revascularization with LITA demonstrates its efficacy in complex coronary interventions.
- The management strategy highlights a multidisciplinary approach to severe procedural complications.
Abstract:
Coronary artery rupture has been known as one of the complications of coronary balloon angioplasty. In this report, we describe a case of coronary artery rupture, who underwent emergency surgery for hemostasis and coronary revascularization. A 67-year-old-male with frequent angina attacks was admitted to our institution for possible coronary angioplasty. Coronary angiogram showed diffuse disease of the mid left anterior descending artery (LAD), with two 90% stenosis. Conventional balloon angioplasty was performed, however, coronary artery rupture occurred while the stent was expanded with a 3.5 mm balloon catheter. Though pericardial drainage improved his hemodynamic state, subsequent coronary angiogram revealed leakage of contrast medium. Emergency surgery was determined at this point for hemostasis and revascularization of the LAD. The revascularization was completed with the left internal thoracic artery (LITA) to the LAD. On the contrary, since the epicardial hemorrhage around the proximal LAD did not spread any further after systemic heparinization, the epicardial surface was covered with a piece of oxidazed cellulose and fibrin glue. After the surgery, the hemodynamic state improved gradually. Postoperative coronary angiogram revealed an aneurysm of the LAD, as well as excellent LITA-LAD patency.