ABSTRACT
A 49-year-old man with impaired left ventricular function successfully underwent a one-stage operation of coronary artery bypass grafting (CABG) and replacement of infrarenal abdominal aortic aneurysm (AAA). Left ventricular ejection fraction, left ventricular end-diastolic and mean pulmonary artery pressures were 24%, 25mmHg and 33mmHg, respectively. The AAA was 6cm in diameter and accompanied by bilateral common iliac artery aneurysm. After completion of CABG, AAA replacement was performed during extracorporeal circulation. There were no hemodynamic changes associated with aortic clamping or declamping under the mechanical cardiac assist during AAA surgery. This procedure appeared to be a feasible one-stage procedure in patients with AAA and coronary artery disease accompanied by impaired left ventricular function.
ABSTRACT
The left IMA graft to the LAD showed a string sign with no antegrade flow in an asymptomatic 67-year-old man 3 years after the operation. The LAD lesion had regressed from 95% stenosis to less than 50% during this period. Exercise electrocardiographic and thallium 201 myocardial scintigraphic examinations revealed no ischemia in the LAD region. When the LAD was temporarily occluded by a PICA balloon, the anterograde flow from the IMA to the LAD could be demonstrated by angiography. The IMA graft in no flow situation has maintained anatomical patency for 3 years after the operation.