Emergency surgical treatment for acute occlusion of the left main coronary artery-report of a case-.

We report a case of acute occlusion of the left main coronary artery (LMCA) successfully treated with percutaneous transluminal coronary angioplasty (PTCA) under the use of percutaneous cardiopulmonary bypass support (PCPS) and subsequent coronary artery bypass grafting (CABG). CABG was started only two hours after admission, and subsequent reperfusion of left anterior descending artery (LAD) after completing distal and proximal anastomosis was achieved 60 minutes later. Although postoperative CK levels were elevated to 10,900 IU/l, akinesis of the left ventricular (LV) wall was limited to segment #1 and #2, and hypokinesis in segment #3 and #6 documented by postoperative left ventriculogram (LVG). The patient was discharged from the hospital on foot without neurologic sequelae and is doing well and in New York Heart Association (NYHA) functional class I in 20 months of follow-up. Simultaneous efforts to maintain systemic circulation and to achieve reperfusion of the occluded LMCA as soon as possible are essential for survival. Prompt introduction of mechanical circulatory support and early revascularization to minimize the infarct area are both necessary.

Coronary artery bypass surgery in patients with abdominal aortic aneurysm: detection and treatment of concomitant coronary artery disease.

OBJECTIVES: Complication due to coronary artery disease (CAD) is a major cause of mortality in the surgical treatment of abdominal aortic aneurysm (AAA). The purpose was to show 1) the incidence of patients who required coronary artery bypass grafting (CABG), and 2) risk factors for the necessity of CABG in patients with AAA. METHODS: Subjects were consecutive 159 patients (132 males and 27 females) undergoing elective repair of non-ruptured AAA between May 1993 and March 2002. Most patients (n=145) underwent routine preoperative coronary angiography (CAG) and received coronary revascularization when necessary. Clinical atherosclerotic risk factors were subjected to univariate and multivariate analysis to determine predictors for the necessity of CABG. RESULTS: Of 43 patients (27.0%) with significant coronary stenosis, 7 patients (4.4%) underwent CABG concomitantly (n=1) or prior to the AAA repair (n=6) in the same admission. Other patients received percutaneous transluminal coronary angioplasty (PTCA) (n=14) and isolated medical treatment (n=22). Overall mortality of 159 patients undergoing AAA repair was 2.5% and there were no deaths in 7 patients undergoing CABG. Univariate and multivariate analysis indicated only the history of angina as significant for the necessity of CABG in patients with AAA. Of 155 survivors, 5 patients underwent CABG later in the follow-up period. CONCLUSIONS: The incidence of patients who required CABG in the treatment of AAA was 4.4% in our institute. It was difficult to predict the necessity of CABG without conducting CAG in patients with asymptomatic myocardial ischemia. These results may justify the routine enforcement of preoperative CAG in patients with AAA.