Simultaneous off-pump coronary artery bypass grafting [CABG] and right upper lobectomy for critical left anterior descending artery [LAD] stenosis and aspergilloma

58 years old man with a history of ischemic heart disease presented with massive hemoptysis. On evaluation with CT chest, he was found to have a large aspergilloma in the left upper lobe. Coronary angiogram was also performed for increasing episodes of angina which showed critical 100% ostial left anterior descending [LAD] stenosis. In view of aspergilloma and hemoptysis, patient could not have conventional open heart surgery and heparinization. Therefore, coronary artery bypass grafting [CABG] was performed on beating heart and this was followed by left upper lobectomy at the same time. Patient had an uneventful post-operative course