Nakanaga Hiroshi, Bando Akifumi, Nagaoka Yoshinari, Ota Mitsuhiko, Tabata Minoru
Department of Cardiovascular Surgery, Cardiovascular Center, Toranomon Hospital, Tokyo, Japan.
Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan.
JACC Case Rep. 2025 Jun 4;30(13):103556. doi: 10.1016/j.jaccas.2025.103556.
Left main coronary artery occlusion during surgical left atrial appendage closure is a rare but critical complication.
We report 2 cases of left main coronary artery occlusion diagnosed intraoperatively during concomitant surgical left atrial appendage closure with a clipping device via an endoscopic minimally invasive approach. Both cases were successfully managed by suturing the clip to the left atrial wall, distancing it from the coronary artery.
Previous reports have documented this complication, but this is the first report of using this particular resolution method. Our approach provides a physiological solution to left main coronary artery obstruction, offering a practical and effective strategy for intraoperative management.
TAKE-HOME MESSAGE: Awareness and prompt management of this complication are crucial during LAAO procedures. The novel method of suturing the clip to the cranial left atrial wall effectively resolves the issue.
在外科左心耳封堵术中左冠状动脉主干闭塞是一种罕见但严重的并发症。
我们报告2例在通过内镜微创方法使用夹闭装置进行同期外科左心耳封堵术时术中诊断出左冠状动脉主干闭塞的病例。两例均通过将夹子缝合至左心房壁，使其与冠状动脉保持距离而成功处理。
既往报道过这种并发症，但这是首次报道使用这种特定解决方法。我们的方法为左冠状动脉主干梗阻提供了一种生理性解决方案，为术中管理提供了一种实用且有效的策略。
在左心耳封堵术过程中，对这种并发症的认识和及时处理至关重要。将夹子缝合至左心房顶部壁的新方法有效解决了该问题。
