Muramatsu Koichi, Naganuma Hirokuni, Kawada Noriyasu, Amagaya Suguru
The Jikei University Kashiwa Hospital, Department of Cardiac Surgery, Kashiwa-city, Chiba, Japan.
J Cardiol Cases. 2023 Mar 25;28(1):28-31. doi: 10.1016/j.jccase.2023.03.006. eCollection 2023 Jul.
A 64-year-old woman had undergone coronary artery bypass grafting (CABG) for right coronary occlusion and the Dor procedure for a left ventricular apex aneurysm 10 years previously. A follow-up computed tomography scan showed the evolution of a giant coronary artery aneurysm (CAA) located on the proximal left circumflex artery (CX). It also revealed a previous saphenous vein graft (SVG) that was patent and located on the midline. Surgical exclusion was regarded as invasive, and isolated percutaneous intervention was unsuitable for a wide-necked CAA. Thus, a hybrid approach was planned. First, CABG (SVG-CX) via left thoracotomy was performed. Following the surgery, stent-assisted coil embolization was performed. A coronary angiogram revealed complete CAA exclusion.
Many authors have reported successful repair for coronary artery aneurysm (CAA) with a percutaneous approach or surgery. Although there is no consensus for giant CAA repair, surgical repair including resection, ligation, and coronary artery bypass grafting have been recommended in previous reports. However, every decision should be tailored to suit each condition. In this case with the history of previous cardiovascular surgery, our hybrid approach was thought to be less invasive and feasible than isolated surgical or percutaneous repair.
一名64岁女性10年前因右冠状动脉闭塞接受了冠状动脉旁路移植术（CABG），并因左心室心尖部动脉瘤接受了Dor手术。随访计算机断层扫描显示，位于左回旋支动脉（CX）近端的巨大冠状动脉瘤（CAA）在演变。扫描还显示一条先前的大隐静脉移植血管（SVG）通畅，位于中线。手术切除被认为具有侵入性，而单纯经皮介入治疗不适用于宽颈CAA。因此，计划采用杂交手术方法。首先，通过左胸切开术进行CABG（SVG-CX）。手术后，进行了支架辅助弹簧圈栓塞术。冠状动脉造影显示CAA完全闭塞。
许多作者报道了经皮方法或手术成功修复冠状动脉瘤（CAA）。尽管对于巨大CAA的修复尚无共识，但先前的报告推荐了包括切除、结扎和冠状动脉旁路移植术在内的手术修复方法。然而，每个决策都应根据具体情况量身定制。在该例有既往心血管手术史的患者中，我们认为杂交手术方法比单纯手术或经皮修复的侵入性更小且可行。
