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.
First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Katsuyuki
K
Asai
Kazuya
K
Suzuki
Naoki
N
Washiyama
Hitoshi
H
Terada
Katsushi
K
Yamashita
Teruhisa
T
Kazui
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