Watanabe A, Kazui T, Mawatari T, Kawamura H, Inaoka M, Komatsu S
Department of Surgery (Section 2), Sapporo Medical College, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Dec;41(12):2441-5.
A 47-year-old man who had undergone surgery of a dissecting thoracic aortic aneurysm was admitted for a localized, dissecting abdominal aortic aneurysm. Preoperative coronary arteriogram incidentally showed a coronary artery aneurysm (CAA) of the left main trunk. Prior to the operation for abdominal aortic aneurysm, that for the CAA was performed under standard cardiopulmonary bypass conditions with antegrade and retrograde coronary sinus cold blood cardioplegia. A longitudinal incision of the aneurysmal wall was made for the removal of a small thrombus and, the ostia of the left anterior descending artery (LAD), circumflex artery (LCX), intermediate artery (IM) and main trunk were closed from the inside of the aneurysm. The aneurysmal wall was closed without resection of the whole aneurysm. Finally, coronary artery bypass grafting to LAD, LCX and IM was performed. Postoperative course was uneventful with patency of all grafts. The retrograde coronary sinus cardioplagia is effective to prevent thromboembolism of distal coronary arteries due to the antegrade cardioplagia.
一名曾接受过胸主动脉夹层动脉瘤手术的47岁男性因局限性腹主动脉夹层动脉瘤入院。术前冠状动脉造影偶然发现左主干冠状动脉瘤（CAA）。在进行腹主动脉瘤手术前，在标准体外循环条件下，采用顺行和逆行冠状窦冷血心脏停搏液对CAA进行手术。在动脉瘤壁上做纵向切口以清除小血栓，然后从动脉瘤内部封闭左前降支动脉（LAD）、回旋支动脉（LCX）、中间动脉（IM）和主干的开口。未切除整个动脉瘤就关闭了动脉瘤壁。最后，对LAD、LCX和IM进行冠状动脉搭桥术。术后过程顺利，所有移植血管均通畅。逆行冠状窦心脏停搏液对于预防顺行心脏停搏液导致的远端冠状动脉血栓栓塞有效。
