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.