Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane Hidaka, Saitama, 350-1298, Japan.
Department of Pathology, National Cerebral and National Cardiovascular Center, Suita, Osaka, Japan.
J Cardiothorac Surg. 2022 Oct 10;17(1):264. doi: 10.1186/s13019-022-02008-0.
The flow capacity of the in situ internal thoracic artery (ITA) is not necessarily sufficient and can be a cause of hypoperfusion syndrome. We present a catastrophic case of in situ ITA grafting for an isolated left main trunk obstruction 13 years after the modified Bentall operation.
A 33-years-old woman had undergone the modified Bentall operation. Coronary angiography showed a critical stenosis in the left coronary artery. The patient underwent emergency off-pump coronary artery bypass graft with the left ITA to the left anterior descending artery (LAD). On the 7th day, the patient had severe dyspnoea and hypotension. Catheter angiography showed that the ITA was patent; however, blood flow from the in situ ITA was delayed, and reversal flow from the apex to the proximal LAD was found. The patient underwent implantation of a left ventricular assist device.
Concomitant aortocoronary bypass to the circumflex branch will minimise the risk of hypoperfusion, especially for young patients without atherosclerotic disease.
原位内乳动脉（ITA）的血流量不一定充足，可能导致灌注不足综合征。我们报告了 13 年后发生在原位 ITA 搭桥术治疗孤立性左主干阻塞的灾难性病例。
一名 33 岁女性曾行改良 Bentall 手术。冠状动脉造影显示左冠状动脉严重狭窄。患者行急诊非体外循环冠状动脉旁路移植术，使用左 ITA 吻合至左前降支（LAD）。术后第 7 天，患者出现严重呼吸困难和低血压。导管造影显示 ITA 通畅，但原位 ITA 的血流延迟，发现从心尖向近端 LAD 有反流。患者行左心室辅助装置植入术。
同期行冠状动脉旁路移植术吻合至回旋支可最大程度降低灌注不足的风险，特别是对于无动脉粥样硬化疾病的年轻患者。
