Tamura Kentaro, Nomura Fumikazu, Mukai Shogo, Yoshitatsu Masao, Sakao Jun, Ihara Katsuhiko
Department of Cardiovascular Surgery, National Hospital Kure Medical Center, Hiroshima, Japan.
Ann Thorac Cardiovasc Surg. 2003 Jun;9(3):206-8.
Patients with porcelain aorta carry a high risk of cerebral as well as systemic embolism during cardiac surgery. Here we describe a case of severe aortic stenosis and coronary artery disease combined with the circumferentially calcified aorta. The patient was a 77-year-old man who successfully received four coronary artery bypass grafts with in situ arterial grafts without clamping the aorta and aortic valve replacement. Aortic valve replacement and two distal coronary artery anastomoses to the left circumflex artery and obtuse marginal branch were performed under cardiac arrest during hypothermic perfusion with endoaortic balloon occlusion, followed by partial endarterectomy and closure of the aorta buttressed with bovine pericardium under deep hypothermic circulatory arrest. While rewarming, the other two distal coronary anastomoses to the left anterior descending artery and diagonal branch were done on the beating heart in order to minimize cardiac arrest time. On-pump beating heart coronary artery bypass grafting (CABG) can be useful especially for combined complex cardiac surgery.
瓷化主动脉患者在心脏手术期间发生脑栓塞和全身栓塞的风险很高。在此，我们描述一例严重主动脉瓣狭窄合并冠状动脉疾病且主动脉呈环形钙化的病例。患者为一名77岁男性，成功接受了四支冠状动脉原位动脉搭桥术，术中未夹闭主动脉，并进行了主动脉瓣置换。在主动脉内球囊阻断低温灌注心脏停搏期间，进行了主动脉瓣置换以及与左旋支动脉和钝缘支的两个远端冠状动脉吻合，随后在深低温循环停搏下进行了部分动脉内膜切除术并用牛心包加固主动脉闭合。在复温过程中，在跳动的心脏上完成了与左前降支动脉和对角支的另外两个远端冠状动脉吻合，以尽量缩短心脏停搏时间。体外循环下跳动心脏冠状动脉搭桥术（CABG）尤其适用于复杂心脏联合手术。
