Successful Repair of a Proximal Descending Aortic Aneurysm under Hypothermic Circulatory Arrest via Left Thoracotomy after Coronary Artery Bypass Grafting
10.4326/jjcvs.24.276
- VernacularTitle:冠動脈バイパス術後の近位下行大動脈瘤に対する左開胸・超低体温循環停止下人工血管置換術の経験
- Author:
Shigefumi Suehiro
;
Toshihiko Shibata
;
Hirokazu Minamimura
;
Yasuyuki Sasaki
;
Koji Hattori
;
Hiroaki Kinoshita
;
Yoshihiro Shimizu
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
1995;24(4):276-279
- CountryJapan
- Language:Japanese
-
Abstract:
A 61-year-old man, who had previously undergone quadruple coronary artery bypass graft surgery, was successfully treated for proximal descending aortic aneurysm using hypothermic circulatory arrest via a left thoracotomy. Preoperative angiograms revealed that the left internal thoracic artery bypass graft to the LAD was patent, and that the aneurysm was located at the descending aorta just distal to the left subclavian artery. Operative procedures were as follows. A left thoracotomy incision was made through the 4th intercostal space. The common femoral artery and vein were cannulated, and the venous cannula was positioned in the right atrium. The patient was cooled by partial cardiopulmonary bypass until the EEG was isoelectric (24°C rectal temperature), and then circulation was arrested. Left ventricular decompression was not performed. After opening of the aneurysm, proximal anastomosis was performed first at the aorta just distal to the left subclavian artery. Another arterial cannula, connected to the Y-shaped arterial line, was inserted into the graft, and perfusion to the brain was restored through this cannula. Distal anastomosis was then completed, and routine cardiopulmonary bypass was reestablished. After the heart was defibrillated, the patient was rewarmed to 34°C before discontinuing the bypass. Circulatory arrest time and total cardiopulmonary bypass time were 17 minutes and 139 minutes, respectively. Postoperative recovery was uneventful.
