Aortocoronary bypass

Published on: 22.11.2017, last modified on: 26.3.2021

Discipline: Cardiology, Angiology, Surgery, Traumatology and Orthopaedics | Departments: Department of Heart Surgery

The case report describes the hospitalization of a 58 year old male admitted to our department for documented ischemic heart disease with affection of three coronary arteries. The patient underwent a cardiac surgery with the formation of one bypass with arterial graft and one bypass with venous graft. In the postoperative period, fibrillation of atrial fibrillation with successful cardioversion was noted. The patient was admitted to outpatient care on the seventh postoperative day.

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Figure 1 - Coronarography of left coronary artery.

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Figure 2 - Coronarography of left coronary artery.

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Figure 3 - Coronarography of right coronary artery.

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Figure 4 - Great saphenous vein preparation.

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Figure 5 - Sufficient blood flow through arterial graft – left internal mammalian artery.

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Figure 6 - Preparation of distal end of left internal mammalian artery.

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Figure 7 - Distal anastomose suturing (venous graft) on marginal branch of circumflex coronary artery.

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Figure 8 - Left anterior descending coronary artery (LAD).

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Figure 9 - LAD verification.

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Figure 10 - Finally position - proximal anastomosis of venous graft and distal anastomosis of arterial graft.

Anamnesis:

58-year-old man
PA: Diabetes mellitus (treated for 25 years), hypoglycaemic coma in anamnesis, surgery of haemorrhoids, gastroesophageal reflux, hyperlipidaemia treated by statins, VAS, anxiously depressive syndrome
FA: sister - treated diabetes mellitus
PA: Insulin (Novorapid 11-6-6j; Trosiba 20j – 21:00), Talliton 25mg (1/2-0-1/2), Prenessa 2mg (1-0-0), Preventax 100mg (0-1-0), Enelbin (1-0-1), Noflux 10mg (1-0-0), Atorvastatin 40mg (0-0-1), Dobica (1-0-1)
AA: penicilin (exanthema)
DA: ex-smoker (12-50-years-old)
SA: retired, living with his wife
AD: The patient reported a palpitation with spontaneous withdrawal and pressure chest pain during exercise. Due to the symptomatology and cummulation of risk factors for coronary artery disease (IHS), ambulatory cardiologist has performed ergometry. The result of stress ergometry showed signs of silent ischemia. Patient admitted to
cardiology for coronary examination.

Laboratoty results:

ECG: SR, 80min-1, EOS: intermed., PQ 160ms, QRS 100ms, QT: 300ms, STD desc. up to 3mm with negat. T in pre-cardiac electrodes, STD up to 1,5mm v I, II, III, aVF, without ectopia

Lab.: normal values

Imaging methods:

ECHO: Aortosclerosis. Dilatated aortic bulb (41 mm), left ventricle of normal size, no hypertrophy, no segmental kinetic disorders, LVEF: 60-65%, diastolic dysfunction - grade I, left atrium (43mm), mitral insufficiency – grade I, tricuspid insufficiency - grade I, no signs of pulmonary hypertension, no pericardial effusion.

SCG: Common left coronary artery: distal 60% stenosis, RIA: proximal bifurcation stenosis (RIA / RD1) 70-80%, median 1-1-1 and at the beginning of the middle part 90% stenosis; RD1: 70% at beginning, RCX: 50% to 60% stenosis, proximal stenosis 60%, middle bifurcation stenosis (RCX / RM1) 80%, median 1-1-1; ACD: sclerotic section with stenosis up to 80% in the middle part; The RPLD has a stenosis at the end of the middle part about 90%.

Diagnosis:

IHD, stable AP, 3-coronary artery disability, normal LVEF
Arterial hypertension 2nd. degree ESH/ESC VKVR
Diabetes mellitus I with chronic complications
Gastroesophageal reflux
Dyslipidaemia treated by statins
Chronic polytope VAS
Anxiously depressive syndrome
Ex-smoker

Therapy and conclusion:

Treatment strategy:
Patient transferred to a heart surgery department for surgical revascularization (CABG).

Surgery:
CABG in ECC, LIMA to RIA, VSM to RM1, (ACD and RIP nonrevascularizable because of atherosclerotic changes and insufficient vessel diameter) – CPB time: 43min, aortic clamping time: 23min.

Postoperative course:
The postoperative course complicated by the atrial fibrillation onset. Pharmacological conversion was ineffective. Electrocardioversion was performed and SR was induced. On the 7th postoperative day released to outpatient care.

Abbreviations:
ACD – right coronary artery; AP – angina pectoris; CABG – aortocoronary bypass; CPB – cardiopulmonary bypass; ECHO – echocardiography; IHD – ischemic heart disease; LCA – left coronary artery; LIMA – left internal mammalian artery; LVEF – left ventricle ejection fraction; RCX – ramus circumflexus; RD1 – firs diagonal branch; RIA – left anterior descending artery; RIP – ramus interventricularis posterior; RM1 – first marginal branch; RPLD – ramus posterolateralis; SCG - coronarography; SR – sinus rhythm; STD – ST segment depression; VAS – vertebral pain syndrome; VSM – great saphenous vein

Authors declare the case report will not be published in any national or international publications.

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citation: Tomáš Toporcer: Aortocoronary bypass. Multimedia support in the education of clinical and health care disciplines :: Portal of Pavol Jozef Šafárik University in Košice Faculty of Medicine [online] , [cit. 01. 04. 2025]. Available from WWW: https://portal.lf.upjs.sk/articles.php?aid=300. ISSN 1337-7000.