title: Left internal thoracic artery harvesting in pleural symphyses under minimally invasive direct vision.
abstract: In minimally invasive direct coronary artery bypass grafting (MIDCAB), the internal thoracic artery (ITA) is harvested under a direct-vision or videothoracoscopic techniques. However, whatever the technique used, dense pleural adhesions hamper ITA harvesting. We describe the case of a patient who underwent MIDCAB 40 years after a pulmonary resection for tuberculosis. The parietal pleura adhered to the left lung so firmly that we could not enter the intrapleural cavity. Therefore, the ITA was harvested creating an extrapleural tunnel Although this approach resulted in more operating time and bleeding, an anastomosis between the ITA and left anterior descending coronary artery was performed successfully. We believe that MIDCAB can be carried out even in patients with dense pleural adhesions.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Morishita
authors.forename: Y
authors.initials: Y
authors.lastname: Tamiya
authors.forename: K
authors.initials: K
authors.lastname: Komatsu
authors.forename: T
authors.initials: T
authors.lastname: Koshino
authors.forename: T
authors.initials: T
authors.lastname: Abe
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000637:transplantation*; D010994:Pleura / Q000098:blood supply / Q000601:surgery*; D011013:Pneumonectomy; D020775:Thoracic Surgery, Video-Assisted; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000601:surgery