Reconstructing a Coronary Artery Bypass Graft of an Ascending Aorta after an Acute Type I Aortic Dissection
10.4326/jjcvs.36.221
- VernacularTitle:冠動脈バイパス術後６年目に発症したＩ型大動脈解離に対してバイパス中枢側の再建を含む緊急上行置換術を施行した１例
- Author:
Ryota Asano
;
Kojiro Kodera
;
Yuji Suda
;
Akihito Sasaki
;
Masahiro Ikeda
;
Go Kataoka
;
Yasuo Takeuchi
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2007;36(4):221-224
- CountryJapan
- Language:Japanese
-
Abstract:
A 50-year-old man who had coronary artery bypass grafting (LITA-LAD, RA-RCA, SVG-OM-PL) 6 years previously was admitted with acute dissection of the aorta (DeBakey type I). Preoperative computed tomography showed that all coronary bypass grafts were patent. We replaced the graft of the ascending aorta and reconstructed the coronary artery bypass by re-sternotomy, circulatory arrest (rectal temperature: 23.6°C), retrograde cerebral perfusion, and intermittent retrograde cardioplegia. Because a radial artery (RA) graft and a saphenous vein graft (SVG) each had intact orifices, we detached them together and attached the grafts back to the aortic graft wall. He was weaned successfully from cardiopulmonary bypass without difficulty and postoperative transthoracic echocardiography (TTE) showed good left ventricle (LV) function. Postoperative multidetector-row computed tomography (MDCT) showed that the RA graft and SVG were patent. By performing circulatory arrest and intermittent retrograde cardioplegia, we successfully protected the myocardial function of a patient with acute aorta dissection after a CABG and we reconstructed the graft without needing further coronary anastomosis.
