Okamura Y, Mochizuki Y, Iida H, Mori H, Sugita Y, Shimada K
Department of Cardiothoracic Surgery, Dokkyo University School of Medicine, Tochigi, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Jun;45(6):874-7.
An 80-year-old female, who had received coronary artery bypass grafting (CABG) 12 years ago was admitted to our hospital because of unstable angina. The vein grafts to the left anterior descending artery (LAD) and circumflex artery (Cx) were both occluded. Chest computerized tomography showed a severely calcified aorta. An intra-aortic balloon pump was inserted and an urgent reoperation was performed. The patient was positioned for an anterolateral left thoracotomy. The chest was entered through the forth intercostal space. The pericardium was opened parallel to the phrenic nerve. Femorofemoral bypass was instituted. Anastomosis of the saphenous vein graft and the diagonal branch and anastomosis of a second saphenous vein to the old SVG just proximal to the anastomotic site of Cx were performed under a beating heart. Proximal anastomosis of the two saphenous veins and the left subclavian artery was then performed. The patient had an uncomplicated postoperative recovery. A postoperative angiogram showed that the new SVG anastomosed to the diagonal branch was patent while the other new SVG anastomosed to the old SVG/Cx was occluded. The patient was discharged and is now free from angina.
一名80岁女性，12年前接受过冠状动脉旁路移植术（CABG），因不稳定型心绞痛入住我院。左前降支（LAD）和回旋支（Cx）的静脉移植物均闭塞。胸部计算机断层扫描显示主动脉严重钙化。插入主动脉内球囊泵并进行紧急再次手术。患者取左前外侧开胸体位。经第四肋间间隙进入胸腔。心包沿膈神经平行打开。建立股-股旁路。在心脏跳动下进行大隐静脉移植物与对角支的吻合以及另一大隐静脉与Cx吻合部位近端的旧静脉移植物的吻合。然后进行两条大隐静脉与左锁骨下动脉的近端吻合。患者术后恢复顺利。术后血管造影显示，与对角支吻合的新静脉移植物通畅，而与旧静脉移植物/Cx吻合的另一新静脉移植物闭塞。患者出院，目前无心绞痛症状。
