巨大冠状动脉瘤的外科治疗

目的探讨巨大冠状动脉瘤的临床特点和外科治疗要点。方法1996年7月至2004年10月,共手术治疗6例巨大冠状动脉瘤。外科治疗方法采用冠状动脉瘤切除术3例,同期冠状动脉旁路移植术2例、冠状动脉瘤成形术3例。巨大冠状动脉瘤常合并其他心血管疾病,同期行冠状动脉瘘修补手术4例,主动脉瓣置换术3例,主动脉成形术2例,冠状动脉瘤血栓清除术1例。结果所有患者均康复出院,平均体外循环时间(144±26)min(67～207min)。主动脉阻断时间(104±21)min(56～172min)。患者随访8～87个月(平均48个月)。随访中患者症状均消失,无死亡和冠状动脉瘤复发病例。结论巨大冠状动脉瘤是一种严重的心血管疾病,应及时手术治疗。     

Surgical treatment of a giant coronary artery aneurysm: a modified approach

A common surgery for giant coronary artery aneurysms includes aneurysmal ligation and coronary artery bypass grafting. We report a patient with such an aneurysm involving the left main trunk in whom the aneurysmal characteristics precluded this approach. Surgical strategy was modified and the aneurysmal sac was dissected open to define the coronary vasculature before ligating the aneurysm and completing the bypass operation.     

冠状动脉瘤的外科治疗

目的 介绍冠状动脉瘤的临床表现及治疗经验。方法 1996年10月－2000年5月,对6例患者行冠状动脉瘤手术,3例为川崎病,3例为冠状动脉瘘;均行冠状动脉旁路移植术,3例冠状动脉瘘患者同时切除冠状动脉瘤,修补冠状动脉瘘口,1例行主动脉瓣置换术。结果 6例患者无住院死亡和严重并发症。随访无异常。结论 冠状动脉瘤是一较为罕见的心脏病,预后差,应尽早手术治疗。手术原则是切除冠状动脉瘤,行冠状动脉旁路移植术并处理好合并病变。     

Surgical resection of the giant right coronary artery aneurysm

A 74‐year‐old man had undergone two‐vessel coronary artery bypass grafting (CABG), 19 years ago, with the left internal mammary artery (LITA) to the left anterior descending artery and the saphenous vein graft (SVG) to the posterior descending artery. In outpatient care, a thoracic aortic aneurysm was suspected by the chest X‐ray. In the computed tomography, appeared the distal arch aortic aneurysm, abdominal aortic aneurysm (AAA), and giant right coronary artery aneurysm (rCAA). The diameter of rCAA was 70 mm and it oppressed the right atrium and ventricle of the heart. The patient was referred to our hospital. After the initial treatment of distal arch aneurysm and AAA, surgical treatment for the rCAA was performed. The rCAA was resected completely and CABG with new SVG was performed without cardiopulmonary bypass. The histopathology of rCAA wall revealed that the etiology was an atherosclerotic change. The postoperative course was good, the oppressed right heart system was released and the hemodynamics of the tricuspid valve showed improvement.     

Surgical treatment for coronary artery aneurysm

Two successful cases of the surgical treatment for coronary artery aneurysm (non-Kawasaki disease) were reported. The first case had a saccular aneurysm on the left circumflex coronary artery (LCx) #14. Resection of the LCx aneurysm was performed subsequent to single vessel coronary artery bypass grafting (CABG) to the distal portion of LCx#14 under the cardioplegic cardiac arrest. The second case had aneurysms on both the left anterior descending artery (LAD) #7 (fusiform) and the LCx#11 (saccular). After double vessel CABG to LAD#7 and LCx#11, ligation or resection of two aneurysms was performed successfully. Postoperative courses have been uneventful with good angiographic results achieved. Since these surgical procedures demonstrated safety, the patients are expected to achieve a good long-term prognosis.     

Surgical treatment for coronary artery aneurysm

Two successful cases of the surgical treatment for coronary artery aneurysm (non-Kawasaki disease) were reported. The first case had a saccular aneurysm on the left circumflex coronary artery (LCx) #14. Resection of the LCx aneurysm was performed subsequent to single vessel coronary artery bypass grafting (CABG) to the distal portion of LCx#14 under the cardioplegic cardiac arrest. The second case had aneurysms on both the left anterior descending artery (LAD) #7 (fusiform) and the LCx#11 (saccular). After double vessel CABG to LAD#7 and LCx#11, ligation or resection of two aneurysms was performed successfully. Postoperative courses have been uneventful with good angiographic results achieved. Since these surgical procedures demonstrated safety, the patients are expected to achieve a good long-term prognosis.     

Surgical treatment of coronary artery fistula with aneurysm

Two operations for coronary artery aneurysm with fistula are reported. This rare congenital malformation can be associated with acute and chronic complications. Surgical treatment is generally recommended. The surgical strategy remains controversial and is discussed. Retrograde cardioplegic cardiac arrest and retrograde dissection of the fistula are favoured. Conservative treatment of the dilated coronary segments was adopted. In both cases, the postoperative course was uneventful and no residual shunts were diagnosed at postoperative echocardiography.     

Successful surgical treatment of giant coronary artery aneurysm with fistula

Giant coronary artery aneurysm with fistula formation is a rare entity. We report a giant coronary artery aneurysm with a maximum diameter of 70 mm with fistula, in which a favorable course was obtained after surgical treatment. We also review the literature on giant coronary artery aneurysms exceeding 50 mm in maximum diameter.     

Surgical treatment of coronary artery-pulmonary artery fistula with coronary aneurysm]

We experienced 4 cases of coronary artery-pulmonary artery fistula with coronary aneurysm, three patients had symptoms of chest pain, and 1 patient had cardiac murmur. Coronary arteriography showed that three patients had fistulas from the left coronary artery to the pulmonary artery; and that 1 patient had a fistula from both the right and left coronary arteries to the pulmonary artery. Moreover, 1 patient had 90% diameter stenosis of segment 7. The maximum diameter of the coronary aneurysm ranged from 12 to 20 mm (average: 15.3 mm). One patient underwent closure of the opening of the fistula, 2 patients underwent multiple ligatures of fistulas, and 1 patient underwent multiple ligatures of fistulas with coronary artery bypass grafting. The postoperative course of every patient was uneventful. There have been 42 reports on this abnormality in Japan. We should treat the fistula as early as possible to prevent cardiac complications such as myocardial ischemia and rupture of coronary aneurysm.     

Surgical management of giant superior mesenteric artery aneurysm

The superior mesenteric artery (SMA) is an uncommon location of aneurysm formation. This entity is potentially lethal and should be treated once a diagnosis is made. When the aneurysm reaches a large size, there is a high risk of rupture and surgical treatment should not be delayed, although it can be technically demanding because there is a significant portion of bowel at risk for ischemia. Here, we describe our approach for the management of a giant SMA aneurysm.     

Repair of giant coronary artery aneurysm with bilateral coronary to pulmonary artery fistulae

Coronary aneurysms are a rare entity with an angiographic incidence of 0.15–4.9 %. Coronary artery to pulmonary artery fistulae are also rare, having an incidence of 0.1–0.8 %. There are only few case reports of these two entities occurring together in the same patient. We recently successfully surgically treated a 71 year old female with this condition.     

腋动脉真性动脉瘤的手术治疗

目的总结腋动脉真性动脉瘤的诊断和手术治疗体会。方法回顾分析1995年1月至2006年6月收治的16例腋动脉真性动脉瘤的临床资料,收集其病因、临床表现、辅助检查、手术中资料以及术后随访资料等。结果均表现为腋窝搏动性肿物,影像学检查均提示腋动脉瘤,均在全身麻醉下行动脉瘤切除,自体静脉移植腋动脉重建,结果均获得近期临床治愈。随访3~10年,平均5年5个月,1例术后2年出现吻合口狭窄,1例术后3年吻合口闭塞,1例手术后5年死于急性脑出血,余13例无复发或并发症出现。结论腋窝搏动性肿物是腋动脉真性动脉瘤的主要临床表现,无创性超声检查有助于明确诊断,真性动脉瘤切除、血管重建是一种可靠的理想的治疗方法。     

Surgical treatment of giant aneurysm of vertebral-basilar junction

A giant aneurysm of the vertebro-basilar junction is reported. It was successfully treated by ligation of the left vertebral artery, temporary occlusion of the right vertebral and basilar arteries, and evacuation of the aneurysm, following which the neck of the aneurysm was clipped.     

Surgical treatment of aortic arch aneurysm combined with coronary artery stenosis.

OBJECTIVE: We present operative results of aortic arch aneurysm associated with coronary artery stenosis, and evaluate the operative risk of graft replacement of the aortic arch and concomitant coronary artery bypass grafting (CABG). PATIENTS AND METHODS: From January 1991 to December 2001, we treated 16 patients with aortic arch aneurysm and coronary artery stenosis. The patients, 3 women and 13 men (study group) ranged from 58 to 79 years of age, average 68.1 5.3 years. With the aid of deep hypothermic cardiopulmonary bypass, we performed graft replacement of the aortic arch aneurysm and concomitant CABG. We bypassed 31 coronary arteries. The bypass grafts included saphenous vein (n=16), left internal thoracic artery (n=4), right internal thoracic artery (n=1), right gastroepiploic artery (n=5) and inferior epigastric artery (n=2). The number of bypassed coronary arteries per patient ranged from 1 to 3, average 2.1 0.8/patient. A comparative study was performed between the study group and a control group of patients (n=39) who had undergone only graft replacement of the aortic arch. RESULTS: There was no significant difference between the two groups regarding: operation time, cardiopulmonary bypass time, cardiac arrest time, intraoperative bleeding volume, and early mortality rate. However, in the patients (n=4) of the study group who had undergone total arch graft replacement with three vessel CABG, the cardiopulmonary bypass time was significantly longer than that of the patients in the control group who underwent total arch graft replacement (n=19, P<0.05). Two of the 16 study group patients died in the early postoperative period, resulting in 12.5% early mortality rate. In the control group, four of 39 patients (10.3%) died in the early postoperative period. CONCLUSIONS: CABG combined with graft replacement of the aortic arch does not increase operative risk when the number of bypassed vessels is within two vessels, but may increase risk when three or more vessels are bypassed.     

A giant congenital aneurysm of the right coronary artery

A young woman with shortness of breath was diagnosed preoperatively as having a coronary artery aneurysm. The aneurysm originated from the right coronary artery and was extraordinarily large. The aneurysm was excised successfully under extracorporeal circulation.     

Surgical management of arteriosclerotic coronary artery aneurysm.

A 60-year-old man suffered antero-septal myocardial infarction at the age of 56. Coronary angiography demonstrated total occlusion of the left anterior descending artery and a large saccular aneurysm of the right coronary artery. Diffuse coronary ectasia was also shown in the right coronary artery adjacent to the aneurysm. Despite anticoagulant therapy, the aneurysm formed a thrombus and developed coronary artery stenosis distal to the aneurysm. Ligation of the aneurysm and in situ gastroepiploic artery grafting were performed. Sudden heart failure was developed during skin closure. As this condition was considered to be graft hypoperfusion, supplemental saphenous vein grafting was placed. Ligation is a simple, reliable technique to prevent future complications for a large saccular right coronary artery aneurysm, however, gastroepiploic artery might be an inappropriate bypass conduit for the ligated coronary artery with diffuse ectasia.     

A successful surgical treatment of left coronary artery-pulmonary artery fistula with giant saccular aneurysm

A surgical case of left coronary artery-pulmonary artery fistula with giant saccular aneurysm was reported. The aneurysm was successfully resected under total extra-corporeal circulation. The patient was 67-year-old female who was admitted for evaluation of chest pain and heart murmur. On coronary angiography, the diagnosis was made as a coronary artery fistula originating from the left anterior descending artery and draining into the pulmonary artery. The operation was indicated by the fact that the combination with giant saccular aneurysm and positive findings of ischemic changes on exercise electrocardiogram. Intraoperative flowmetry on the fistula revealed that estimated average flow was 200 ml/min and the coronary steal phenomenon was strongly suggested. We concluded that surgical treatment for coronary fistula with giant aneurysm can be done with minimal risk.