脳血管病変を合併する狭心症患者にoff pumpバイパスと経皮的冠動脈血行再建術を施行した1例  [in Japanese] Coronary Artery Bypass Grafting without Cardiopulmonary Bypass and Percutaneous Coronary Angioplasty in a Patient with Cerebrovascular Stenosis.  [in Japanese]

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Abstract

症例は73歳男性. 主訴は労作時胸痛. 血管造影にて左右鎖骨下動脈, 左椎骨動脈に狭窄を有する冠状動脈3枝病変と診断. 上行大動脈にも著明な石灰化を有するため, 通常の大動脈遮断下の冠状動脈バイパス手術は, 脳合併症の危険性が高いため回旋枝領域の病変には術後カテーテル・インターベンションを行うことを前提として拍動下冠状動脈バイパス手術を施行した. 手術は左鎖骨下動脈に狭窄があるため左内胸動脈が使用できず, 右胃大網動脈にてLADに, 大伏在静脈を用い4PDにバイパスを置き大伏在静脈の中枢側は右腕頭動脈に吻合した. 術後造影と同日に回旋枝にステントを留置し良好に退院した. 体外循環が予後に影響を与える可能性がある場合, インターベンションを前提とするバイパス手術は有効な方法の一つと考える.

Complete revascularization of the coronary artery was performed in a 73-year-old man who had severe stenosis of the bilateral subclavian and left vertebral arteries and severe calcification of the ascending aorta. At first, we performed CABG (coronary artery bypass grafting) on the LAD (left anterior descending artery) and the RCA (right coronary artery) without cardiopulmonary bypass. <i>In-situ</i> GEA (gastroepiploic artery) was anastomosed to the LAD and SVG (saphenous vein graft) was anastomosed to 4 PD (4 posterior descending artery) of the RCA. The right brachiocephalic artery was selected as the site of the proximal anastomosis of the SVG. A Palmaz-Schatz stent was then held in place in the LCX (left circumflex artery) postoperatively. The combination of CABG without cardiopulmonary bypass and PTCA was a safe method for preventing cerebrovascular complications in a patient with a severely calcified artery.

Journal

  • Japanese Journal of Cardiovascular Surgery

    Japanese Journal of Cardiovascular Surgery 30(2), 74-76, 2001

    The Japanese Society for Cardiovascular Surgery

Codes

  • NII Article ID (NAID)
    130003629206
  • Text Lang
    JPN
  • ISSN
    0285-1474
  • Data Source
    J-STAGE 
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