Nishina T, Matsuda K, Nomoto S, Nishimura K, Koshiji T, Sato T, Ueyama K, Nonaka M, Ban T
Department of Cardiovascular Surgery, Kyoto University School of Medicine, Japan.
Kyobu Geka. 1998 Feb;51(2):139-41.
A 70-year-old man who developed angina pectoris underwent cardiac catheterization, which showed total occlusion of the left anterior descending coronary artery (LAD), associated with 75% stenosis of the right coronary artery (RCA) and 90% stenosis of the small circumflex coronary artery (CX). The LAD received good collateral flow from the RCA. The patient was scheduled to undergo the MIDCAB for the LAD using the internal thoracic artery (ITA), combined with percutaneous transluminal coronary angioplasty (PTCA) for the RCA subsequently. A left anterior submammarian skin incision of 10 cm in length was made. The fifth costal cartilage was removed. The left ITA was directly harvested from the chest wall from the 4th to 7th intercostal space, and was anastomosed to the midportion of the LAD without cardiopulmonary bypass. The patient was quickly recovered after the operation. On the 8th postoperative day, the patient successfully underwent the PTCA for the RCA after the ITA-LAD graft had been verified to be patent. The MIDCAB could be indicated for multivessel coronary disease in conjunction with the PTCA.
一名患有心绞痛的70岁男性接受了心脏导管插入术，结果显示左前降支冠状动脉（LAD）完全闭塞，同时右冠状动脉（RCA）有75%的狭窄，小回旋支冠状动脉（CX）有90%的狭窄。LAD从RCA获得了良好的侧支血流。该患者计划使用胸廓内动脉（ITA）对LAD进行非体外循环冠状动脉搭桥术（MIDCAB），随后对RCA进行经皮冠状动脉腔内血管成形术（PTCA）。做了一个10厘米长的左胸前皮下切口。切除了第五肋软骨。直接从胸壁第4至第7肋间间隙获取左ITA，并在非体外循环下将其吻合至LAD的中部。患者术后恢复很快。术后第8天，在证实ITA-LAD移植血管通畅后，患者成功接受了RCA的PTCA。MIDCAB联合PTCA可用于多支冠状动脉疾病。
