Iwakura Tomohiro, Toguchi Kouji, Kato Ippei, Asakawa Noriko
Department of Cardiovascular Surgery, Meirikai Chuo General Hospital, 114-0001 Higashi-jyujo Kita-ku, Tokyo, Japan.
J Cardiothorac Surg. 2019 Feb 26;14(1):38. doi: 10.1186/s13019-019-0868-0.
A saccular aneurysm located at the bifurcation of the left main coronary artery (LMCA) is an extremely rare condition. A major cause of left main coronary aneurysm is atherosclerosis, and common complications include thrombosis, embolism, and rupture. Despite the serious nature of this condition, the ideal operative approach to LMCA aneurysm (LMCAA) has not been established. Furthermore, little is known about resection of the saccular aneurysm and closure using a small internal thoracic artery patch.
Here, we present the case of a 66-year-old woman who had significant stenosis in the left anterior descending artery and a saccular aneurysm at the bifurcation of the LMCAA, which was repaired using a small internal thoracic artery patch during coronary artery bypass grafting. Postoperative multislice computed tomography revealed the complete disappearance of the aneurysm and a successful repair with no luminal stenosis of the internal thoracic artery patch. In addition, the left internal thoracic artery graft was found to be patent.
Resection of the saccular LMCA aneurysm and closure using a small internal thoracic artery patch is safe and offer excellent results.
位于左主干冠状动脉（LMCA）分叉处的囊状动脉瘤极为罕见。左主干冠状动脉动脉瘤的主要病因是动脉粥样硬化，常见并发症包括血栓形成、栓塞和破裂。尽管这种情况很严重，但尚未确定针对LMCA动脉瘤（LMCAA）的理想手术方法。此外，关于囊状动脉瘤的切除及使用小的胸廓内动脉补片进行闭合的了解甚少。
在此，我们报告一例66岁女性病例，其左前降支存在严重狭窄，且在LMCAA分叉处有一个囊状动脉瘤，在冠状动脉旁路移植术中使用小的胸廓内动脉补片进行了修复。术后多层计算机断层扫描显示动脉瘤完全消失，修复成功，胸廓内动脉补片无管腔狭窄。此外，发现左胸廓内动脉移植物通畅。
使用小的胸廓内动脉补片切除囊状LMCA动脉瘤并进行闭合是安全的，且效果良好。
