Mukohara N, Asada T, Higami T, Obo H, Gan K, Ogawa K
Hyogo Children Hospital, Kobe, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Jan;44(1):74-7.
A 67-year-old woman having descending thoracic aneurysm and 90% stenosis of the obtuse marginal artery underwent a concomitant operation of graft replacement of a thoracic aneurysm and coronary artery bypass grafting. The operation was performed through left posterolateral thoracotomy with total cardiopulmonary bypass using femoral artery, femoral vein and the pulmonary artery cannulation, deep hypothermia and retrograde cerebral perfusion (RGCP). RGCP was performed by high central venous pressure (17-18 mmHg) resulted from low flow perfusion of the lower body under clamping of the descending aorta. Distal coronary anastomosis was done during an initial 100ling period and proximal anastomosis was put on the replaced thoracic graft after coming off extracorporeal circulation (ECC). ECC time was 167 minutes, and RGCP time was 27 minutes. The patient did well after the operation. Postoperative coronary angiography showed the patent coronary bypass graft. We conclude that this method provides good exposure of the thoracic aorta and the coronary artery, and satisfactory brain protection.
一名67岁女性，患有降主动脉瘤且钝缘支动脉狭窄90%，接受了胸主动脉瘤移植置换术和冠状动脉搭桥术的同期手术。手术通过左后外侧开胸进行，采用股动脉、股静脉和肺动脉插管建立全心肺转流，深低温及逆行脑灌注（RGCP）。RGCP通过在降主动脉阻断下对下半身进行低流量灌注导致的高中心静脉压（17 - 18 mmHg）来实施。远端冠状动脉吻合在最初的100分钟内完成，近端吻合在体外循环（ECC）结束后置于置换的胸段移植物上。ECC时间为167分钟，RGCP时间为27分钟。患者术后恢复良好。术后冠状动脉造影显示冠状动脉搭桥移植血管通畅。我们得出结论，该方法能很好地暴露胸主动脉和冠状动脉，并提供令人满意的脑保护。
