A Case of Proximal Control of Patent Internal Thoracic Artery Graft Flow by a Supraclavicular Approach during Redo Cardiac Surgery
10.4326/jjcvs.34.337
- VernacularTitle:左内胸動脈グラフト開存例における再手術に対し左鎖骨上アプローチによる左内胸動脈遮断が有効であった１例
- Author:
Masahiro Toyama
;
Takeru Shimomura
;
Yasushi Takagi
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2005;34(5):337-341
- CountryJapan
- Language:Japanese
-
Abstract:
A 68-year-old man who had undergone previous coronary artery bypass grafting was admitted with cardiac failure because of aortic valve stenosis and severe mitral valve regurgitation. Preoperative cardiac catheterization showed a patent left internal thoracic artery (LITA) and a stenotic saphenous vein graft. We performed aortic valve replacement, mitral valve repair, and coronary artery bypass grafting with repeat sternotomy, moderate hypothermia (29.3°C), aortic cross-clamping, retrograde cardioplegia and proximal occlusion of the LITA graft using a soft bulldog clamp. The proximal LITA was occluded through a supraclavicular incision without intrathoracic dissection. Although cardiopulmonary bypass (CPB) time and aortic cross-clamp time were prolonged, the patient was taken off CPB without any problem. The postoperative course was uneventful. We believe that this technique is safe and effective for establishing myocardial protection without deep hypothermia and risk of LITA injury.
