Emergency surgical treatment for acute occlusion of the left main coronary artery-report of a case-.
We report a case of acute occlusion of the left main coronary artery (LMCA) successfully treated with percutaneous transluminal coronary angioplasty (PTCA) under the use of percutaneous cardiopulmonary bypass support (PCPS) and subsequent coronary artery bypass grafting (CABG). CABG was started only two hours after admission, and subsequent reperfusion of left anterior descending artery (LAD) after completing distal and proximal anastomosis was achieved 60 minutes later. Although postoperative CK levels were elevated to 10,900 IU/l, akinesis of the left ventricular (LV) wall was limited to segment #1 and #2, and hypokinesis in segment #3 and #6 documented by postoperative left ventriculogram (LVG). The patient was discharged from the hospital on foot without neurologic sequelae and is doing well and in New York Heart Association (NYHA) functional class I in 20 months of follow-up. Simultaneous efforts to maintain systemic circulation and to achieve reperfusion of the occluded LMCA as soon as possible are essential for survival. Prompt introduction of mechanical circulatory support and early revascularization to minimize the infarct area are both necessary.
Takahashi
Junichiro
J
Division of Cardiovascular Surgery, Aishin Memorial Hospital, Hokkaido, Japan.
Sugiki
Takashi
T
Okude
Jun
J
Gohda
Toshihiro
T
Murakami
Taiji
T
Sasaki
Shigeyuki
S
Yasuda
Keishu
K
D015906:Angioplasty, Balloon, Coronary; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D004632:Emergency Medical Services; D006801:Humans; D008297:Male; D008875:Middle Aged