Extensive Reconstruction Of Left Anterior Descending Artery With Coronary Aneurysm And Full-metal Jacket
Suguru Ohira1, Hitoshi Yaku1, Satoshi Numata1, Sachiko Yamazaki1, Tomoya Inoue1, Keiichi Itatani1, Kazuki Morimoto1, Shuichiro Takanashi2.
1Kyoto Prefectural University of Medicine, Kyoto, Japan, 2Sakakibara Heart Institute, Tokyo, Japan.
[Patient Demographics] A 75-year-old man had 2-vessel disease with normal ejection fraction and left ventricle size. The patient did not have any valve lesions. [Relevant History] He underwent multiple bare-metal stenting for the left anterior descending artery (LAD) occlusion 16 years previously; however, aneurysmal formation was found at the site of proximal stents and the stents were totally occluded 1 year after the intervention. The aneurysm and distal LAD were supplied through a false lumen that became markedly stenotic (99% with delay) with accompanying angina during the previous 6 months. The posterior descending artery (PDA) showed a 90% stenotic lesion. [Pre-Operative Plan] Since multiple stents (arrows) were placed from a proximal part of the aneurysm to distal LAD beyond the last diagonal branch, the aneurysm resection, stent removal with endarterectomy, and onlay patch grafting of the LAD with in-situ left internal thoracic artery (LITA) were planned. [Discussion] The LITA was harvested with a skeletonized fashion using a harmonic scalpel. The LAD was reconstructed with an in-situ LITA with a long anastomosis (6.5 cm) after stent removal with endarterectomy. The inflow of the aneurysm was ligated. The great saphenous vein was anastomosed to PDA as an aortocoronary bypass. A histopathological examination showed marked stenosis of the false lumen and true coronary aneurysm. Postoperative coronary angiography showed excellent LITA graft flow to the reconstructed LAD with patent diagonal and septal branches. Patient had no symptom with a normal left ventricular function 6-month after the operation.
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