| Emergency Reoperation for Vein
Graft Rupture Caused by PCI Failure |
(Department of Cardiovascular Surgery, Rakuwakai
Otowa Hospital, Kyoto, Japan)
| Nozomu Sasahashi |
Koji Ueyama |
|
|
A 68-year-old woman on chronic hemodialysis
was admitted to our hospital for further evaluation because of
recurrent angina 14 months after coronary bypass surgery (left
internal thoracic artery-left anterior descending artery (LITA-LAD),
gastro-epiploic artery-4 posterior descending artery (GEA-4PD),
saphenous vein graft-＃9-＃14 sequential (SVG-＃9-＃14 sequential)).
On coronary angiography, a localized 90% stenosis of the vein
graft was present at the anastomosis with the diagonal branch
of the native coronary artery. Although the lesion was relieved
with a 5mm balloon catheter inflated to 14 atmospheres, contrast
injection demonstrated extravasation of dye into the pericardial
space, indicating vein graft rupture. Repositioning the inflated
balloon across the rupture site for hemostasis was unsuccessful,
and the patient was transferred to the operating room. Emergency
reoperation was accomplished through a left lateral thoracotomy
without cardiopulmonary bypass. Although hemorrhage was not noted
at the rupture site, the vein graft was ligated at the proximal
and distal portions of the rupture, followed by a new vein graft
bypass. Postoperative cardiac catheterization clearly demonstrated
the patent graft. Although localized hypokinesis was observed
in the lateral wall on postoperative echocardiography, the left
ventricular ejection fraction was 67%, her activity level was
good, and she had no angina.
Jpn. J. Cardiovasc. Surg. 33：205-207 (2004) |
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