Fujiwara H, Hirotani T, Kato Y, Shirota S, Kameda T
Department of Cardiovascular Surgery, Tokyo Saiseikai Central Hospital, Japan.
Kyobu Geka. 1999 May;52(5):368-71.
Severe calcification of the ascending aorta makes coronary artery bypass grafting (CABG) complicated since aortic cross-clamping may induce cerebral embolization of aortic debris or aortic dissection. Furthermore, there are problems that the distal aortic occlusion becomes incomplete and proximal anastomosis between the ascending aorta and saphenous veins becomes impossible. CABG for a 56 year-old male with severely calcified ascending aorta was successfully conducted using hypothermic circulatory arrest technique. His right internal thoracic artery was bypassed to LAD under fibrillatory arrest and then his right gastroepiploic artery was bypassed to the distal portion of RCA under hypothermic circulatory arrest. There was no complication and left ventricular ejection fraction improved from 16% to 38% postoperatively.
升主动脉严重钙化会使冠状动脉旁路移植术(CABG)变得复杂,因为主动脉交叉钳夹可能会诱发主动脉碎片的脑栓塞或主动脉夹层。此外,还存在远端主动脉闭塞不完全以及升主动脉与大隐静脉之间近端吻合无法进行的问题。一名56岁升主动脉严重钙化的男性患者采用低温循环停止技术成功进行了CABG。在颤动停止下,他的右胸廓内动脉被旁路移植至左前降支,然后在低温循环停止下,他的右胃网膜动脉被旁路移植至右冠状动脉远端。术后无并发症,左心室射血分数从16%提高到了38%。