Combined operation for myasthenia gravis and coronary artery disease.
A 57-year-old man with ocular myasthenia gravis was admitted to our hospital because of acute respiratory insufficiency associated with myasthenic crisis. He had a history of unstable angina indicated percutaneous coronary artery angioplasty. He was diagnosed with generalized nonthymomatous myasthenia gravis and a triple vessel coronary artery disease. We conducted a simultaneous surgical intervention, including extended thymectomy and coronary artery bypass grafting, using a standard cardiopulmonary bypass via median sternotomy. The patient had already been immunocompromised at surgery for having diabetes, and postoperative long-term steroid therapy. In this rare and special condition, a meticulous overall therapeutic strategy was needed in order to avoid myasthenic crisis and prepare for the worst case scenario of mediastinitis.
Asai
Katsuyuki
K
First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Suzuki
Kazuya
K
Washiyama
Naoki
N
Terada
Hitoshi
H
Yamashita
Katsushi
K
Kazui
Teruhisa
T
D002315:Cardiopulmonary Bypass; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000453:epidemiology / Q000601:surgery*; D013934:Thymectomy