CASE REPORTS   

Chirurgia 2016 February;29(1):16-20

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Staged operation for coronary artery disease and abdominal aortic aneurysm complicated with congenital dual left anterior descending coronary artery

Satoshi YAMASHIRO, Ryoko ARAKAKI, Yuya KISE, Hitoshi INAFUKU, Yukio KUNIYOSHI

Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan

A dual left anterior descending artery is an extremely rare congenital coronary anomaly that has no clinical significance unless superimposed with atherosclerotic coronary artery disease. We describe a 71-year-old Caucasian male with a dual left anterior descending artery who presented with angina pectoris and a gradually expanding abdominal aortic aneurysm. Coronary angiography revealed a type 3 dual left anterior descending coronary artery and three-vessel disease with left main trunk stenosis. The optimal treatment of patients with critical coronary artery disease and a large or symptomatic abdominal aortic aneurysm remains controversial. We scheduled a staged operation to treat the rapidly expanding abdominal aortic aneurysm and coronary disease in our patient because the one-stage on-pump approach is associated with increased risk of bleeding and other overlapping complications that might be attributable to either procedure. We initially treated the abdominal aortic aneurysm by endovascular aortic aneurysm repair because it had expanded by about 5 mm during short period. Two weeks later, the patient underwent a coronary artery bypass graft. We considered that the management strategy selected for this patient was apparently optimal. Compared with conventional surgical approaches, endovascular aortic aneurysm repair followed by coronary artery bypass grafting was less invasive. This rare coronary artery anomaly is clinically important from the viewpoint of myocardial revascularization.