CASE REPORTS  THORACIC PAPERS 

The Journal of Cardiovascular Surgery 2000 June;41(3):495-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Left internal thoracic artery harvesting in pleural sym-physes under minimally invasive direct vision

Morishita K., Tamiya Y., Komatsu K., Koshino T., Abe T.

From the Department of Thoracic and Cardiovascular Surgery Sapporo Medical University School of Medicine, Sapporo, Japan

In min­i­mally inva­sive ­direct cor­o­nary ­artery ­bypass ­grafting (­MIDCAB), the ­internal tho­racic ­artery (ITA) is har­vested ­under a ­direct-­vision or vid­eo­tho­rac­os­copic tech­niques. How­ever, what­ever the tech­nique ­used, ­dense ­pleural adhe­sions ­hamper ITA har­vesting. We ­describe the ­case of a ­patient who under­went ­MIDCAB 40 ­years ­after a pul­mo­nary resec­tion for tuber­cu­losis. The ­parietal ­pleura ­adhered to the ­left ­lung so ­firmly ­that we ­could not ­enter the intra­pleural ­cavity. There­fore, the ITA was har­vested ­creating an extra­pleural ­tunnel. ­Although ­this ­approach ­resulted in ­more oper­ating ­time and ­bleeding, an anas­tom­osis ­between the ITA and ­left ante­rior ­descending cor­o­nary ­artery was per­formed suc­cess­fully. We ­believe ­that ­MIDCAB can be car­ried out ­even in ­patients ­with ­dense ­pleural adhe­sions.