Left thoracotomy for coronary bypass in a patient with pectus excavatum

Choghari, Chaouki; Heymans, O; Geens, M; Joris, M

doi:10.1016/0003-4975(96)00496-1

Cited by 7 publications

(4 citation statements)

References 2 publications

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“…Some surgeons have proposed that sternotomy be abandoned entirely in favor of left thoracotomy for repeat approach to the mediastinum. 6 Although coexisting pectus and coronary artery disease has been treated in single or staged procedures, 7 we found no published reports of coronary surgery through resternotomy after pectus repair.…”

Section: Discussionmentioning

confidence: 91%

Coronary Artery Bypass via Resternotomy after Pectus Excavatum Repair

Mohan

Stark

Costic

et al. 2005

The American Surgeon™

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Pectus excavatum is a chest wall deformity that commonly warrants pediatric surgical correction for cosmesis or respiratory impairment via sternotomy. The repair typically consists of sternal wedge osteotomy and subsequent placement of a Steinman pin across the sternum with fixation to the ribs bilaterally. Coronary artery bypass grafting (CABG) after surgical repair of the sternum with a metal implant poses an intriguing surgical challenge. Literature review reveals only one such previously described case. We present a case of coronary revascularization in an adult who previously underwent pectus excavatum repair with ligation of the internal mammary arteries. Our coronary revascularization was accessed through a resternotomy after surgical removal of the metal implant previously placed during the pectus excavatum repair. Autologous greater saphenous vein was used as a conduit for bypass. The patient did well postoperatively and was discharged on postoperative day 4. The pectus repair remained intact even after the median sternotomy was performed. This was confirmed at the 1-year follow-up for the patient. Resternotomy after pectus excavatum repair with a prosthetic implant poses a challenge to cardiothoracic surgeons. Many such repairs have been described in the pediatric population. As our society ages and coronary artery disease becomes more prevalent, this unique situation may be more commonly encountered. We present an approach to coronary artery bypass grafting via median resternotomy after pectus excavatum repair.

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Section: Discussionmentioning

confidence: 91%

Coronary Artery Bypass via Resternotomy after Pectus Excavatum Repair

Mohan

Stark

Costic

et al. 2005

The American Surgeon™

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“…4,5) In this patient, who underwent a redo Bentall procedure, the right coronary artery as reconstructed by the button technique was very close to the sternum, which made repeat median sternotomy much more dangerous. Moreover, the LITA could not be dissected via repeat median sternotomy because of the pectus excavatum.…”

Section: Discussionmentioning

confidence: 92%

Left Coronary Ostial Stenosis after the Modified Bentall Using a Long Interposed Coronary Graft in a Patient with Pectus Excavatum

Kato¹,

Hattori²,

Motoki³

et al. 2014

ATCS

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A 26-year-old man presented chest oppression. He had pectus excavatum associated with Loeys-Dietz syndrome and a history of redo aortic root replacement with the modified Bentall technique using an 8-mm long interposed graft to the left coronary ostium. Coronary angiography revealed severe stenosis of both left coronary ostium and proximal left anterior descending artery, which was supposed to be resulted from thrombosis in the interposed graft. The left coronary system was bypassed through a left thoracotomy, which was suitable in this patient because the pectus excavatum would prevent harvest of the left internal thoracic artery through re-median sternotomy and to avoid potential sternal reentry injury of the heart. Although the left anterior descending artery was easily accessed under off-pump technique, exposure and anastomosis of the circumflex coronary artery was more difficult than expected without cardiopulmonary bypass as the pectus excavatum and adhesion of the heart prevented anterior shift and rotation of the heart.

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“…However, this procedure can cause postoperative respiratory disorders, costal cartilage bending, ischemic bone necrosis, and resultant osteomyelitis. [3][4][5] An alternative approach is left anterior thoracotomy, 6,7 which, along with minimally invasive CABG, can help prevent complications associated with median resternotomy, though it is unsuitable for multivessel disease. We selected on-pump beating CABG to clearly expose all the target vessels in our patient, whose anteroposterior chest diameter had increased.…”

Section: Discussionmentioning

confidence: 99%

Coronary artery bypass grafting after sternal turnover procedure and a review of the literature

et al. 2021

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We report a case of complete revascularization after a sternal turnover procedure through median sternotomy in a patient with multivessel coronary artery disease. The patient had unusual anatomical features, such as the anterior protrusion of the middle‐to‐distal sternum and absent bilateral internal thoracic arteries (ITAs). The single‐blade sternum retractor and the Omni‐Tract retractors are simple and reliable tools for lifting and widening the thoracic wall around the xiphoid process. The bilateral radial arteries and the great saphenous vein were used as bypass grafts. Computed tomography was used to visualize the sternum supplied by the superior epigastric arteries (SEAs); presurgical abdominal ultrasonography revealed the course and crossing point of the developed SEAs. Since ITAs were absent, we preserved the SEAs to prevent sternal ischemia. No sternal complications or graft occlusion were observed during follow‐up.

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Left thoracotomy for coronary bypass in a patient with pectus excavatum

Cited by 7 publications

References 2 publications

Coronary Artery Bypass via Resternotomy after Pectus Excavatum Repair

Coronary Artery Bypass via Resternotomy after Pectus Excavatum Repair

Left Coronary Ostial Stenosis after the Modified Bentall Using a Long Interposed Coronary Graft in a Patient with Pectus Excavatum

Coronary artery bypass grafting after sternal turnover procedure and a review of the literature

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