Case Report
A 48-year-old-man with MFS underwent ARR using a mechanical valve and a
dacron graft for type A acute aortic dissection. Accidentally bilateral
COA (left: 27×21 mm, right: 19×17 mm) was found by a computed tomography
(CT) at 13 years after previous surgery. We decided to perform
re-operation because bilateral coronary ostial aneurysm enlarged by 5mm
and over per year (left: 32×26 mm, right: 25×21 mm) without any symptoms
(Figure 1).
Re-median sternotomy was performed. Cardiopulmonary bypass was
established between the left common femoral artery and right atrium.
Whole tissue around dacron graft including coronary ostium were severely
adhered. We could not employ the anatomical reconstruction of coronary
ostium using button technique because the remnant of coronary button was
very fragile to make coronary button for anastomosis. We decided to
perform the short segment CABG using RA graft to the left main trunk
(LMT) and right coronary artery (RCA). The LMT, left anterior descending
artery, left circumflex artery and RCA could be identified near the
aortic root and isolated with silicone strings respectively. The both
coronary ostia were resected from the graft and were directly closed
with 5/0 monofilament. The side-to-end distal anastomosis to the LMT and
RCA using RA were performed with 7/0 monofilament and proximal
anastomosis to the aortic root were performed with 6/0 monofilament.
A postoperative CT showed CABG were patent (Figure 2). The patient was
discharged uneventfully on postoperative day 19th. Histopathological
examination of the aneurysms showed cystic medial necrosis associated
with MFS.