Okamoto Yuki, Shimura K, Katsu M, Inoue H, Kaga S, Ogata K, Suzuki S, Shindo S, Matsumoto M
Second Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan.
Kyobu Geka. 2009 May;62(5):413-6.
We report a case of aortic valve replacement and repeat coronary artery bypass grafting in a patient with a patent internal thoracic artery bypass graft. A 77-year-old man, who underwent coronary artery bypass grafting (CABG) 10 years ago, was admitted to the hospital for aortic stenosis and angina pectoris. Transthoracic echocardiography demonstrated severe aortic calcification with an 86 mmHg gradient across the aortic valve. Coronary angiography demonstrated the patency of all grafts and 90% stenosis of the left circumflex coronary artery. At surgery, a full median sternotomy was performed. The adhesions around the heart and great vessels were severe and the left internal thoracic artery (LITA) was found adherent to the heart and sternum. The LITA and saphenous vein graft (SVG) graft were dissected carefully. Retrograde coronary sinus (CS) perfusion was performed with antegrade myocardial protection for cardiac arrest. We performed aortic valve replacement (AVR) with a 17 mm St. Jude Medical Regent Valve and CABG to the circumflex artery with the saphenous vein under cardiopulmonary bypass. His postoperative course was uneventful. He was discharged from our hospital without major complications.
我们报告一例接受主动脉瓣置换术并再次进行冠状动脉搭桥术的患者，该患者胸廓内动脉搭桥移植血管通畅。一名77岁男性，10年前接受过冠状动脉搭桥术（CABG），因主动脉瓣狭窄和心绞痛入院。经胸超声心动图显示严重的主动脉钙化，主动脉瓣跨瓣压差为86 mmHg。冠状动脉造影显示所有移植血管通畅，左旋支冠状动脉狭窄90%。手术时，行全胸骨正中切开术。心脏和大血管周围粘连严重，发现左胸廓内动脉（LITA）与心脏和胸骨粘连。小心分离LITA和大隐静脉移植血管（SVG）。在心脏停搏时采用顺行心肌保护措施并进行逆行冠状窦（CS）灌注。我们在体外循环下用17 mm圣犹达医疗Regent瓣膜进行主动脉瓣置换术（AVR），并用大隐静脉对左旋支动脉进行冠状动脉搭桥术。他的术后病程顺利。他从我院出院，无重大并发症。
