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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1999 August;40(4):535-8

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Surgical management of arteriosclerotic coronary artery aneurysm

Shimizu T., Hirayama T., Koizumi N., Ishimaru S., Nakai H., Tsuchida H.

From the Department of Surgery II Tokyo Medical University, Tokyo, Japan


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A 60-­year-old man suf­fered ­antero-­septal myo­car­dial infarc­tion at the age of 56. Cor­o­nary angio­graphy dem­on­strated ­total occlu­sion of the ­left ante­rior ­descending ­artery and a ­large sac­cular aneu­rysm of the ­right cor­o­nary ­artery. Dif­fuse cor­o­nary ­ectasia was ­also ­shown in the ­right cor­o­nary ­artery adja­cent to the aneu­rysm. ­Despite anti­co­ag­u­lant ­therapy, the aneu­rysm ­formed a ­thrombus and devel­oped cor­o­nary ­artery sten­osis ­distal to the aneu­rysm. Liga­tion of the aneu­rysm and in ­situ gas­troep­i­ploic ­artery ­grafting ­were per­formed. ­Sudden ­heart ­failure was devel­oped ­during ­skin clo­sure. As ­this con­di­tion was con­sid­ered to be ­graft hypo­per­fu­sion, sup­ple­mental saph­e­nous ­vein ­grafting was ­placed. Liga­tion is a ­simple, reli­able tech­nique to pre­vent ­future com­pli­ca­tions for a ­large sac­cular ­right cor­o­nary ­artery aneu­rysm, how­ever, gas­troep­i­ploic ­artery ­might be an inap­pro­priate ­bypass con­duit for the ­ligated cor­o­nary ­artery ­with dif­fuse ­ectasia.

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