scholarly journals Anomalous aortic origin of right and circumflex coronary arteries - procedural risks during combined aortic valve replacement and coronary artery bypass grafting

2018 ◽  
Vol 146 (7-8) ◽  
pp. 440-444
Author(s):  
Mladen Kocica ◽  
Milica Karadzic ◽  
Milos Grujic ◽  
Dragan Cvetkovic ◽  
Ljiljana Soskic
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Arteries ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Coronary Artery Anomalies ◽  
The Right ◽  
Congenital Coronary Artery Anomalies

Introduction. Anomalous aortic origin of the right and the circumflex coronary arteries presents extremely rare and potentially dangerous combination in patients scheduled for combined coronary bypass grafting and aortic valve replacement surgery. We report this illustrative case to emphasize the importance of meticulous diagnostic setup enabling the surgeon to anticipate and avoid numerous possible pitfalls. Case outline. A 74-year-old woman, with anterior-wall myocardial infarction and aortic valve stenosis, underwent successful combined coronary artery bypass grafting and aortic valve replacement. Preoperative coronary angiography revealed unusually high take-off of the right main coronary trunk and anomalous origin and course of the circumflex coronary artery. Anatomy of both anomalous coronary arteries in the light of underlying surgical pathology necessitated a meticulous preparation and caution during successive phases of surgical treatment. Conclusion. Estimating potential procedural risk should be standard practice for each patient with known congenital coronary artery anomalies, regardless of the natural risk imposed by a particular anomaly. Preoperative evaluation of coronary circulation, with high surgical awareness and knowledge of different congenital coronary artery anomalies, should be a standard approach in cardiac surgical practice. This would add a predictive value for an actual procedural risk in cases of previously unrecognized anomalies.

scholarly journals Combined Aortic Valve Replacement and Coronary Bypass Grafting in Patient With Lipton’s R-III Type of Single Coronary Artery Anomaly

2021 ◽  
Author(s):  
Milica Karadzic Kocica ◽  
Hristina Ugrinovic ◽  
Dejan Lazovic ◽  
Nemanja Karamarkovic ◽  
Milos Grujic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Rare Condition ◽  
Single Coronary Artery ◽  
Bypass Grafting ◽  
Congenital Coronary Artery Anomalies

A single coronary artery is a very rare condition, commonly associated with other congenital anomalies. It could be generally classified as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches. By presenting the patient with an isolated single coronary artery, who underwent successful combined aortic valve replacement and coronary artery bypass grafting surgery, we intend to distinguish casual from causal in this extremely rare clinical and surgical scenario. This is the first-ever case published, combining such underlying pathology, clinical presentation, and surgical treatment.

Aortic Valve Replacement and Concomitant Right Coronary Artery Bypass Grafting Performed via a Right Minithoracotomy Approach

2014 ◽  
Vol 9 (4) ◽  
pp. 302-305 ◽  
Author(s):  
Christos G. Mihos ◽  
Orlando Santana ◽  
Andres M. Pineda ◽  
Angelo La Pietra ◽  
Joseph Lamelas
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Right Coronary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
The Mean ◽  
The Right

Objective We present our experience of concomitant right coronary artery bypass grafting (CABG) and aortic valve replacement performed via a right minithoracotomy in patients with coronary lesions not amenable to percutaneous intervention. Methods A total of 17 patients underwent concomitant aortic valve replacement and right CABG between April 2008 and July 2013.A5-to 6-cm minithoracotomy incision was made over the right second or third intercostal space, and the costochondral cartilage was transected. A saphenous vein bypass to the right coronary artery was then performed, initiating the anastomosis from the toe of the graft. Subsequently, the aortic valve was replaced using standard techniques. Results There were 6 men and 11 women. The median European System for Cardiac Operative Risk Evaluation II score mortality risk was 5% [interquartile range (IQR), 2%-8%]. The mean (SD) age was 77 (10) years, the left ventricular ejection fraction was 59% (8%), and the New York Heart Association functional class was 2.4 (0.8). One patient had a history of CABG. The mean (SD) cardiopulmonary bypass time was 168 (57) minutes, and the aortic cross-clamp time was 133 (36) minutes. Three patients underwent concomitant mitral valve surgery (replacement, 2; repair, 1). The median intensive care unit and hospital lengths of stay were 47 hours (IQR, 24–90) and 9 days (IQR, 5–13), respectively. There was one reoperation for bleeding, and there was one postoperative stroke. All patients were alive at a mean (SD) follow-up of 2 (1.1) years. Conclusions Aortic valve replacement with concomitant CABG performed via a right minithoracotomy approach is feasible.

scholarly journals Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Aditya Eranki ◽  
Claudia Villanueva ◽  
Nicholas Collins ◽  
Peng Seah
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Coronary Artery Bypass ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Bypass Grafting ◽  
Ventricular Thrombus

Abstract Introduction Left ventricular (LV) thrombus is a complication of acute myocardial infarction and is associated with systemic thromboembolism. We describe a trans-aortic endoscopic approach to the removal of an LV thrombus in a patient undergoing concurrent coronary artery bypass grafting and aortic valve replacement. Case presentation A 47 year old male presented following an embolic middle cerebral artery stroke and underwent transthoracic echocardiography demonstrating a mobile LV thrombus. Additional investigation revealed a moderately stenosed bicispid aortic valve, two vessel coronary artery disease and ischemic cardiomyopathy. The patient underwent early surgery to reduce the risk of further embolic episodes. A trans-aortic approach was utilized with videoscopy and single shafted instrumentation to aide in removal of the thrombus. The patient then underwent aortic valve replacement and coronary artery bypass grafting. Conclusion We report an alternative technique for the removal of a left ventricular thrombus in a patient undergoing concurrent coronary and aortic valve surgery. The transaortic video-assisted approach provided excellent visualisation of the apex and near complete removal of the thrombus without damaging the surrounding trabeculae. The main benefit of this technique is sparing of LV tissue, thereby preserving left ventricular function.

scholarly journals Clinical case: aortic valve replacement with aortic root reconstruction and coronary artery bypass grafting in 73-yo obese female patient

2018 ◽  
Vol 9 (1) ◽  
pp. 71-75
Author(s):  
D. V. Borisov ◽  
A. S. Zotov ◽  
S. A. Vachev ◽  
A. V. Troitskiy ◽  
R. I. Khabazov
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Female Patient ◽  
Valve Replacement ◽  
Aortic Root ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Obese Female

Aortic valve replacement is the second most common cardiac surgery procedure. Prosthesis-patient size mismatch can increase the incidence of adverse events postoperatively, it also leads to increased left ventricular load. Some studies describe the higher mortality in this group of patients. It is also proved that patients with severe aortic stenosis usually have impaired platelet aggregation and low von Willebrand factor causing bleeding disorders. We report a case of successful aortic valve replacement and aortic root enlargement (Nicks technique) combined with coronary artery bypass grafting (left internal mammary artery to the left anterior descending artery) and left atrial appendage resection in 73-y.o. obese female patient. Postoperative course was uneventful.

Combined coronary artery bypass grafting and aortic valve replacement

2021 ◽  
pp. 451-454
Author(s):  
Christopher Lau ◽  
Leonard N. Girardi
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Coronary Artery Bypass ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Cardiac Procedures

Aortic valve replacement and/or coronary artery bypass grafting (CABG) have become the most common cardiac procedures as the population ages and life expectancy increases. In isolation, both CABG and aortic valve replacement are performed with excellent outcomes throughout the world with operative mortalities of 1–2%. Both procedures have seen significant advances in recent years. The combination of an aortic valve procedure and CABG adds increased complexity and risk, which must be accounted for during operative planning in order to mitigate as much of the increased risk as possible. Improvements in postoperative care, myocardial protection, and operative techniques for combined CABG and aortic valve replacement have resulted in an operative mortality of 0.8–6.4% in recent series.

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