Iida Mitsuru, Orime Yukihiko, Umeda Tomofumi, Ishii Yusuke, Shiono Motomi
Department of Cardiovascular Surgery, Surugadai Nihon Univer sity Hospital, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2014;20 Suppl:754-7. doi: 10.5761/atcs.cr.12.01968. Epub 2013 Jan 31.
A 67-year-old man who had undergone substernal gastric tube interposition due to esophageal cancer showed ST changes on electrocardiography. Diagnosis was severe stenosis of the left anterior descending branch that required emergency coronary artery bypass grafting. Preoperative computed tomography (CT) showed the feeding arteries of the gastric tube were in contact with the left internal mammary artery. Therefore, we felt harvesting this artery could be dangerous and decided to perform a median sternotomy, approaching from the right side of the gastric tube. The pericardium was easily and safely reached. We undertook on-pump cardiac arrest single coronary artery bypass grafting of the left anterior descending artery with a saphenous vein graft. The postoperative course was uneventful without mediastinitis. Cardiac surgery after esophageal cancer is often performed from a left thoracotomy. But, we recommend a median sternotomy be performed as an option. Preoperative contrast-enhanced CT should be considered as it may indicate the need for a significant revision such as a median sternotomy.
一名因食管癌接受胸骨后胃管置入术的67岁男性在心电图检查中出现ST段改变。诊断为左前降支严重狭窄，需要紧急冠状动脉旁路移植术。术前计算机断层扫描（CT）显示胃管的供血动脉与左乳内动脉接触。因此，我们认为采集该动脉可能有危险，决定采用正中胸骨切开术，从胃管右侧入路。心包很容易且安全地显露。我们在体外循环心脏停搏下用大隐静脉移植对左前降支进行单支冠状动脉旁路移植术。术后过程顺利，无纵隔炎。食管癌术后心脏手术通常采用左胸开胸进行。但是，我们建议可选择正中胸骨切开术。应考虑术前增强CT，因为它可能提示需要进行如正中胸骨切开术等重大术式调整。
