Ohtani N, Kiyokawa K, Asada H, Kawakami T, Haga M, Sasajima T
Department of Cardiovascular Surgery, Shin-Nittetsu Muroran General Hospital, Hokkaido, Japan.
Jpn J Thorac Cardiovasc Surg. 2000 Apr;48(4):247-50. doi: 10.1007/BF03218133.
The patient was a 77-year-old female who had been treated medically for angina pectoris since 5 years ago. Expanded aneurysms in the distal aortic arch and in the descending thoracic aorta were seen during follow-up. She presented continuous back-pain at rest along with increasing size of the aneurysms despite antihypertensive therapies after admission. First, two saphenous vein grafts were anastomosed to the left anterior descending artery and obtuse marginal artery under beating heart. Next, the proximal portion of the left subclavian artery was clamped and divided. To this graft, the proximal ends of the coronary bypassed vein grafts were anastomosed and coronary perfusion was established and maintained until this artery was anastomosed to the aortic graft. Then, the aneurysms in the distal arch and descending thoracic aorta were excised and the aorta and its two pairs of intercostal arteries were reconstructed. The Postoperative course was uneventful with favorable cardiac function.
该患者为77岁女性，自5年前起就因心绞痛接受药物治疗。随访期间发现主动脉弓远端和胸降主动脉有扩张性动脉瘤。入院后，尽管进行了抗高血压治疗，但她仍持续出现静息时背痛，且动脉瘤大小不断增加。首先，在心脏跳动的情况下，将两根大隐静脉移植物分别吻合至左前降支动脉和钝缘支动脉。接下来，夹闭并切断左锁骨下动脉近端。将冠状动脉搭桥静脉移植物的近端吻合至该移植物，并建立和维持冠状动脉灌注，直至该动脉与主动脉移植物吻合。然后，切除主动脉弓远端和胸降主动脉的动脉瘤，并重建主动脉及其两对肋间动脉。术后过程顺利，心功能良好。
