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Reversal flow in the left anterior descending artery after internal thoracic artery grafting

BACKGROUND: The flow capacity of the in situ internal thoracic artery (ITA) is not necessarily sufficient and can be a cause of hypoperfusion syndrome. We present a catastrophic case of in situ ITA grafting for an isolated left main trunk obstruction 13 years after the modified Bentall operation. CA...

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Autores principales: Nakajima, Hiroyuki, Takazawa, Akitoshi, Nakamura, Yoshitsugu, Ishibashi-Ueda, Hatsue, Yoshitake, Akihiro, Iguchi, Atsushi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9552515/
https://www.ncbi.nlm.nih.gov/pubmed/36217166
http://dx.doi.org/10.1186/s13019-022-02008-0
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author Nakajima, Hiroyuki
Takazawa, Akitoshi
Nakamura, Yoshitsugu
Ishibashi-Ueda, Hatsue
Yoshitake, Akihiro
Iguchi, Atsushi
author_facet Nakajima, Hiroyuki
Takazawa, Akitoshi
Nakamura, Yoshitsugu
Ishibashi-Ueda, Hatsue
Yoshitake, Akihiro
Iguchi, Atsushi
author_sort Nakajima, Hiroyuki
collection PubMed
description BACKGROUND: The flow capacity of the in situ internal thoracic artery (ITA) is not necessarily sufficient and can be a cause of hypoperfusion syndrome. We present a catastrophic case of in situ ITA grafting for an isolated left main trunk obstruction 13 years after the modified Bentall operation. CASE PRESENTATION: A 33-years-old woman had undergone the modified Bentall operation. Coronary angiography showed a critical stenosis in the left coronary artery. The patient underwent emergency off-pump coronary artery bypass graft with the left ITA to the left anterior descending artery (LAD). On the 7th day, the patient had severe dyspnoea and hypotension. Catheter angiography showed that the ITA was patent; however, blood flow from the in situ ITA was delayed, and reversal flow from the apex to the proximal LAD was found. The patient underwent implantation of a left ventricular assist device. CONCLUSIONS: Concomitant aortocoronary bypass to the circumflex branch will minimise the risk of hypoperfusion, especially for young patients without atherosclerotic disease. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13019-022-02008-0.
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spelling pubmed-95525152022-10-12 Reversal flow in the left anterior descending artery after internal thoracic artery grafting Nakajima, Hiroyuki Takazawa, Akitoshi Nakamura, Yoshitsugu Ishibashi-Ueda, Hatsue Yoshitake, Akihiro Iguchi, Atsushi J Cardiothorac Surg Case Report BACKGROUND: The flow capacity of the in situ internal thoracic artery (ITA) is not necessarily sufficient and can be a cause of hypoperfusion syndrome. We present a catastrophic case of in situ ITA grafting for an isolated left main trunk obstruction 13 years after the modified Bentall operation. CASE PRESENTATION: A 33-years-old woman had undergone the modified Bentall operation. Coronary angiography showed a critical stenosis in the left coronary artery. The patient underwent emergency off-pump coronary artery bypass graft with the left ITA to the left anterior descending artery (LAD). On the 7th day, the patient had severe dyspnoea and hypotension. Catheter angiography showed that the ITA was patent; however, blood flow from the in situ ITA was delayed, and reversal flow from the apex to the proximal LAD was found. The patient underwent implantation of a left ventricular assist device. CONCLUSIONS: Concomitant aortocoronary bypass to the circumflex branch will minimise the risk of hypoperfusion, especially for young patients without atherosclerotic disease. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13019-022-02008-0. BioMed Central 2022-10-10 /pmc/articles/PMC9552515/ /pubmed/36217166 http://dx.doi.org/10.1186/s13019-022-02008-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Nakajima, Hiroyuki
Takazawa, Akitoshi
Nakamura, Yoshitsugu
Ishibashi-Ueda, Hatsue
Yoshitake, Akihiro
Iguchi, Atsushi
Reversal flow in the left anterior descending artery after internal thoracic artery grafting
title Reversal flow in the left anterior descending artery after internal thoracic artery grafting
title_full Reversal flow in the left anterior descending artery after internal thoracic artery grafting
title_fullStr Reversal flow in the left anterior descending artery after internal thoracic artery grafting
title_full_unstemmed Reversal flow in the left anterior descending artery after internal thoracic artery grafting
title_short Reversal flow in the left anterior descending artery after internal thoracic artery grafting
title_sort reversal flow in the left anterior descending artery after internal thoracic artery grafting
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9552515/
https://www.ncbi.nlm.nih.gov/pubmed/36217166
http://dx.doi.org/10.1186/s13019-022-02008-0
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