[Graft replacement of a thoracic aneurysm and coronary artery bypass grafting using retrograde cerebral perfusion through left thoracotomy--a case report].
A 67-year-old woman having descending thoracic aneurysm and 90% stenosis of the obtuse marginal artery underwent a concomitant operation of graft replacement of a thoracic aneurysm and coronary artery bypass grafting. The operation was performed through left posterolateral thoracotomy with total cardiopulmonary bypass using femoral artery, femoral vein and the pulmonary artery cannulation, deep hypothermia and retrograde cerebral perfusion (RGCP). RGCP was performed by high central venous pressure (17-18 mmHg) resulted from low flow perfusion of the lower body under clamping of the descending aorta. Distal coronary anastomosis was done during an initial 100ling period and proximal anastomosis was put on the replaced thoracic graft after coming off extracorporeal circulation (ECC). ECC time was 167 minutes, and RGCP time was 27 minutes. The patient did well after the operation. Postoperative coronary angiography showed the patent coronary bypass graft. We conclude that this method provides good exposure of the thoracic aorta and the coronary artery, and satisfactory brain protection.
Mukohara
N
N
Hyogo Children Hospital, Kobe, Japan.
Asada
T
T
Higami
T
T
Obo
H
H
Gan
K
K
Ogawa
K
K
D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D010477:Perfusion; D013908:Thoracotomy / Q000379:methods*