| A Case of Coronary Artery Bypass
Grafting through the Left Thoracotomy after Substernal Gastric
Interposition for Carcinoma of the Esophagus |
(Department of Cardiovascular Surgery, Osaka City
General Hospital, Osaka, Japan)
| Yasuyuki Kato |
Satoru Miyamoto |
Hirokazu Minamimura |
| Takumi Ishikawa |
Tadahiro Murakami |
Hiroyuki Nishi |
| Kensuke Ohue |
Yoshihiro Shimizu |
|
|
We present here a rare case of coronary
artery bypass grafting through a left thoracotomy after substernal
gastric interposition for esophageal cancer. A 58-year-old man,
who had undergone esophagectomy and substernal gastric interposition
11 years previously, was admitted for cerebral infarction from
which he made a good recovery without any complication. At this
time, the patient was diagnosed as having coronary artery disease
on electrocardiogram. Cardiac catheterization revealed triple
vessel disease. Coronary artery bypass grafting to the left anterior
descending artery and obtuse marginal branch through a left thoracotomy
was performed using a radial artery Y-graft under femorofemoral
bypass. The aorta was cross-clamped and the heart was arrested
with antegrade cold cardioplegic solution for the distal anastomosis
of the left anterior descending artery and the obtuse marginal
branch which was embedded within the myocardium. The postoperative
angiography showed good coronary flow. Left thoracotomy approach
provides a good exposure of the left coronary artery. This approach,
therefore, is advocated as an alternative method for cases requiring
coronary artery bypass but in which median sternotomy is difficult,
such as the present case. The appropriate procedure for the site
of thoracotomy, supporting methods, choice of graft, and the
site of graft anastomosis should be selected in each patient.
Jpn. J. Cardiovasc. Surg. 32: 276 -279 (2003) |
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