title: Off-pump minimally invasive direct coronary artery bypass in patients with cosmetic prosthesis for pectus excavatum.
abstract: Pectus excavatum can be associated with coronary artery diseases that can become difficult to manage in urgent situations. We describe the use of an off-pump minimally invasive direct coronary artery bypass (MIDCAB) through the fourth intercostal space incision in a patient with pectus excavatum and acute coronary syndrome who previously underwent a cosmetic prosthesis implantation. The patient refused any surgical procedure that could compromise the integrity of his cosmetic prosthesis and a left mini-thoracotomy was a good option to avoid the removal of the prosthesis. The preservation of the integrity of the thoracic cage enhanced chest wall stability and pulmonary function and permitted avoidance of inadvertent cardiac structure iatrogenic injuries. MIDCAB was optimal for the exposure of the left internal thoracic artery and the left anterior descending artery. The deformity of the chest should not be considered as an absolute contraindication to off-pump MIDCAB when other surgical options are not viable, even in emergency situations.
authors.affiliation: Department of Cardiac Surgery, Azienda Ospedaliero Universitaria, Ospedale Civile Santissima Annunziata, Sassari, Italy drmassi@katamail.com checcopanza@katamail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massi
authors.affiliation: Department of Cardiac Surgery, Azienda Ospedaliero Universitaria, Ospedale Civile Santissima Annunziata, Sassari, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Manca
authors.affiliation: Department of Cardiac Surgery, Azienda Ospedaliero Universitaria, Ospedale Civile Santissima Annunziata, Sassari, Italy.
authors.forename: Mirko
authors.initials: M
authors.lastname: Muretti
authors.affiliation: Department of Cardiac Surgery, Azienda Ospedaliero Universitaria, Ospedale Civile Santissima Annunziata, Sassari, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Portoghese
mesh_terms: D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis; D005660:Funnel Chest / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019736:Prostheses and Implants; D013908:Thoracotomy / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Chest wall; Coronary disease; Minimally invasive surgery; Myocardial infarction