| Combined Coronary Artery Bypass
Grafting, Abdominal Aortic Repair and Aortic Valve Replacement
in a Case with Porcelain Aorta |
(Department of Surgery II, Ehime University School
of Medicine, Ehime, Japan)
| Kanji Kawachi |
Tatsuhiro Nakata |
Yoshihiro Hamada |
| Shinji Takano |
Nobuo Tsunooka |
Yoshitsugu Nakamura |
| Atsushi Horiuchi |
Katsutoshi Miyauchi |
Yuuji Watanabe |
|
A 73-year-old woman was admitted
to undergo three simultaneous operations: aortic valve replacement
(AVR), coronary artery bypass grafting (CABG) and abdominal aortic
aneurysm repair. She had previously undergone percutaneous catheter
intervention in the left coronary anterior descending artery.
Computed tomography revealed an abdominal aortic aneurysm 5 cm
in diameter. Aortic valve stenosis (AS) was shown with a pressure
gradient of 60 mmHg, and 90% stenosis of the distal right coronary
artery was also shown. CT scan and aortography revealed porcelain
ascending aorta. The patient underwent simultaneous operations
because of severe AS, coronary artery disease and abdominal aortic
aneurysm. An aortic cannula was placed in a position higher in
the ascending aorta with no calcification. Cardiopulmonary bypass
was started using a two-staged venous cannula through the right
atrium. At first, AVR was performed with cardioplegic solution
and ice slush. Because it was difficult to inject the cardioplegic
solution into the coronary artery selectively due to the calcified
orifice of coronary artery, we closed it immediately by removing
the calcified intima of the porcelain aorta after completion
of AVR. The second cardioplegic solution was injected through
the ascending aorta. Next, CABG to RCA was performed using the
right gastroepiploic artery without anastomosis to the ascending
aorta. Cardiac surgery was first performed, followed by abdominal
aortic aneurysm repair after discontinuation of cardiopulmonary
bypass. The patient was extubated the next day and stayed for
two days in the intensive care unit. She is very well now one
year after the operation.
Jpn. J. Cardiovasc. Surg. 31：344-346 (2002) |
|
