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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 1998 April;39(2):229-32

CARDIAC PAPERS 

    CASE REPORTS

Bilateral thor­a­cot­o­my for cor­o­nary ­artery ­bypass graft­ing in a ­patient ­with unfa­vor­able ­median ster­not­o­my

Sato T., Isomura T., Hisatomi K.*, Nayashida N.**

From the Cardiovascular Surgery Shonan Kamakura General Hospital, Kanagawa, Japan
*Second Department of Surgery Kagoshima University School of Medicine
**Second Department of Surgery Kurume University School of Medicine, Fukuoka, Japan

In ­this ­report, we ­describe a ­patient who under­went cor­o­nary ­artery ­bypass graft­ing (­CABG) ­through bilat­er­al thor­a­cot­o­my and dis­tal ­median ste­rnot­o­my, ­because he had ­received ter­mi­nal tr­a­cheot­o­my as a treat­ment to pre­vent aspi­ra­tion pneu­mo­nia due to Wallenberg’s syn­drome. On the ­first day ­after the ter­mi­nal tra­che­ot­o­my, he sud­den­ly com­plained of ­severe ante­ri­or ­chest ­pain. Emergency cor­o­nary angio­gram ­revealed com­plete occlu­sion of the prox­i­mal ­right cor­o­nary ­artery (RCA), ­severe sten­o­sis of the ­left ante­ri­or descend­ing ­artery (LAD) and the ­large ­first diag­o­nal ­branch. Catheter inter­ven­tion for RCA was attempt­ed but it was unsuc­cess­ful, and there­fore he was ­required to ­have ­urgent oper­a­tion. The ­patient had ­received ­total laryn­gec­to­my and ter­mi­nal t­rach­e­ot­o­my two ­weeks ­before ­urgent ­CABG, and the ­large ­hole of the t­rach­e­ot­o­my was ­just ­placed ­above the inci­su­ra juglar­is of the ster­num. So ­high ­risks of ster­nal infec­tion and ­severe med­i­as­tin­itis ­after ordi­nary ­median ster­not­o­my ­were con­sid­ered and we ­applied the bilat­er­al thor­a­cot­o­my ­approach. To our knowl­edge, ­this is ­very ­rare but effec­tive ­approach to vas­cu­lar­ize ­both ­right and ­left cor­o­nary ­artery and to use ­both ­left inter­nal tho­rac­ic ­artery (­LITA) and gas­troep­i­plo­ic ­artery (GEA) ­graft. It ­seemed ­that ­this ­approach is ­safe and effec­tive for car­diac sur­gery in ­such sit­u­a­tions ­that ­median ster­not­o­my is not favor­able as in the ­described ­patient or in ­patients hav­ing reop­er­a­tion.

language: English


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