Koike N, Kaneko T, Ezure M, Sato Y, Aizaki M, Okada S, Morishita Y
Division of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
Kyobu Geka. 2006 Nov;59(12):1089-94.
We experienced 2 cases of surgical treatment for left atrial myxoma combined with coronary artery bypass grafting (CABG) using only in situ arterial grafts. A 58-year-old man who had undergone CABG [left internal thoracic artery (LITA)-right coronary artery (RCA) and saphenous vein graft (SVG)-left anterior descending artery (LAD)] 14 years before was admitted to our hospital, complaining of anterior chest pain. Coronary arteriography demonstrated total occlusion of the LAD and RCA, as well as the stenosis of high lateral branch (HL) and SVG. Left atrial myxoma was incidentally detected by echocardiography. Myxoma was resected at first, and then the right internal thoracic artery (RITA) was anastomosed to the LAD. The postoperative course was uneventful. A 69-year-old woman was admitted to another hospital, complaining of chest pain and dyspnea. Coronary arteriography revealed stenosis of LAD, left circumflex artery (LCx) and HL, as well as left main trunk (LMT). Left atrial myxoma was incidentally detected by echocardiography. Myxoma was resected at first, and then CABG [LITA-HL, gastroepiploic artery (GEA)-RCA and RITA-LAD] was carried out. The postoperative course was uneventful. The priority between CABG and the surgical treatment for cardiac myxoma remains controversial from the point of view of myocardial protection and prevention of systemic embolism of myxomal fragment.
我们遇到了2例仅使用原位动脉移植物进行左心房黏液瘤合并冠状动脉旁路移植术(CABG)的手术治疗病例。一名58岁男性,14年前接受了CABG(左内乳动脉-LITA至右冠状动脉-RCA以及大隐静脉移植物-SVG至左前降支-LAD),因胸痛入院。冠状动脉造影显示LAD和RCA完全闭塞,以及高位侧支-HL和SVG狭窄。经超声心动图偶然发现左心房黏液瘤。首先切除黏液瘤,然后将右内乳动脉-RITA吻合至LAD。术后过程顺利。一名69岁女性因胸痛和呼吸困难入住另一家医院。冠状动脉造影显示LAD、左旋支-LCx和HL以及左主干-LMT狭窄。经超声心动图偶然发现左心房黏液瘤。首先切除黏液瘤,然后进行CABG(LITA至HL、胃网膜动脉-GEA至RCA以及RITA至LAD)。术后过程顺利。从心肌保护和预防黏液瘤碎片全身栓塞的角度来看,CABG和心脏黏液瘤手术治疗的先后顺序仍存在争议。