Pratt J W, Williams T E, Michler R E, Brown D A
Division of Cardiothoracic Surgery, The Ohio State University, Columbus 43210-1228, USA.
Ann Thorac Surg. 2000 Oct;70(4):1366-70. doi: 10.1016/s0003-4975(00)01937-8.
Left thoracotomy is infrequently used for cardiac procedures, but its application in reoperative and minimally invasive coronary revascularization and in valvular procedures has been reported recently.
Three case reports and a review of the current literature illustrate the unique benefits of this approach for myocardial revascularization and valve replacement.
Reoperative coronary revascularization of the left anterior descending and circumflex coronary arteries was performed off-pump via a left posterolateral thoracotomy. For the second case, this approach was used for coronary artery bypass grafting of the right coronary and left anterior descending arteries with femoral-femoral cardiopulmonary bypass in a patient with congestive heart failure and coronary artery disease who also required closure of a patent ductus arteriosus. In the third case, mitral valve replacement using femoral venous and aortic cannulation for cardiopulmonary bypass was performed via a left thoracotomy to avoid a retrosternal gastric conduit in a patient with severe mitral stenosis and congestive heart failure. All patients returned to normal activity and are asymptomatic.
These case reports and a comprehensive review of the literature demonstrate the utility of left thoracotomy as an alternative approach to standard median sternotomy in selected cases of revascularization and valvular procedures.
左胸切开术在心脏手术中很少使用，但最近有报道称其在再次手术、微创冠状动脉血运重建及瓣膜手术中的应用。
三例病例报告及对当前文献的综述阐述了这种方法在心肌血运重建和瓣膜置换方面的独特优势。
通过左后外侧胸切开术在非体外循环下对左前降支和回旋支冠状动脉进行再次手术冠状动脉血运重建。第二例中，对于一名患有充血性心力衰竭和冠状动脉疾病且还需要闭合动脉导管未闭的患者，采用这种方法在股-股体外循环下对右冠状动脉和左前降支进行冠状动脉旁路移植术。第三例中，对于一名患有严重二尖瓣狭窄和充血性心力衰竭的患者，通过左胸切开术，采用股静脉和主动脉插管进行体外循环，实施二尖瓣置换术，以避免胸骨后胃通道。所有患者均恢复正常活动且无症状。
这些病例报告及对文献的全面综述表明，在选定的血运重建和瓣膜手术病例中，左胸切开术作为标准正中胸骨切开术的替代方法具有实用性。
