Saricaoglu Mehmet Cahit, Corbacioglu Yusuf, Boga Salih Anil, Deniz Serenay, Dincer İrem, Akar Ahmet Ruchan
Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Türkiye.
Department of Cardiovascular Surgery, Gaziantep City Hospital, Ankara, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2024 Dec 31;32(4 Suppl 2):114-115. doi: 10.5606/tgkdc.dergisi.2024.mep-19. eCollection 2024 Nov.
A dilated coronary artery segment larger than 1.5 times the diameter of the reference vessel defines coronary artery aneurysm. Herein, we reported a case of left main trifurcation aneurysm, a challenging anatomy. A 57-yearold female was referred to our department with an exertional angina. The patient had no significant medical history, except for hyperlipidemia and previous history of smoking. All diagnostic tests were standard. However, an electrocardiogram showed anterior T-wave inversion. Computed tomography angiography revealed a saccular left main coronary artery (LMCA) aneurysm at the trifurcation level. Coronary angiography demonstrated a giant saccular aneurysm at the trifurcation of LMCA, measuring 32×21 mm with tight postaneurysmal stenosis in the intermediate artery. The patient underwent surgery under general anesthesia. A median sternotomy was performed. After cannulation and aortic cross-clamping, an LMCA trifurcation giant aneurysm was exposed on the posterolateral aspect of the heart by the help of stay thick nylon tapes, which were passed through oblique and transverse sinuses. The giant saccular aneurysm was carefully dissected. The branches of trifurcation were visualized, and the aneurysm sac was resected. A meticulous endarterectomy was performed at the trifurcation level and reconstructed with saphenous vein roof plasty. Then, the intermediate artery was revascularized with a saphenous graft from ascending aorta. The aortic cross-clamp time was 52 min, and the cardiopulmonary bypass time was 75 min. The patient had an uneventful hospitalization and was discharged on aspirin and warfarin therapy. This case demonstrates that the surgical reconstruction of giant saccular LMCA aneurysms using a saphenous graft patch is safe and allows for percutaneous interventions when necessary.
直径大于参考血管直径1.5倍的冠状动脉节段扩张定义为冠状动脉瘤。在此，我们报告了一例左主干三分叉动脉瘤病例，这是一种具有挑战性的解剖结构。一名57岁女性因劳力性心绞痛转诊至我科。该患者除高脂血症和既往吸烟史外，无其他重大病史。所有诊断检查均为标准检查。然而，心电图显示前壁T波倒置。计算机断层扫描血管造影显示在三分叉水平有一个囊状左主干冠状动脉（LMCA）动脉瘤。冠状动脉造影显示LMCA三分叉处有一个巨大的囊状动脉瘤，大小为32×21 mm，中间动脉瘤后狭窄严重。患者在全身麻醉下接受手术。行正中胸骨切开术。插管和主动脉交叉夹闭后，借助穿过斜窦和横窦的粗尼龙带，在心脏后外侧暴露LMCA三分叉巨大动脉瘤。仔细解剖巨大囊状动脉瘤。显露三分叉分支，切除动脉瘤囊。在三分叉水平进行细致的内膜切除术，并用大隐静脉瓣修补术进行重建。然后，用来自升主动脉的大隐静脉移植物对中间动脉进行血运重建。主动脉交叉夹闭时间为52分钟，体外循环时间为75分钟。患者住院过程顺利，出院时接受阿司匹林和华法林治疗。该病例表明，使用大隐静脉移植物补片对巨大囊状LMCA动脉瘤进行手术重建是安全的，并且在必要时允许进行经皮干预。
