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J Thorac Cardiovasc Surg 2003;125:958-960
© 2003 The American Association for Thoracic Surgery

Brief Communications

Abdominal aneurysm rupture and left main stenosis: Emergency one-stage repair with off-pump coronary surgery

Gerard Babatasi, MD, PhD, Massimo Massetti, MD, Jean-Michel Radoux, MD, Andre Khayat, MD Caen, France

From the Cardiovascular Surgery Department, University Hospital CHU Caen, France.

Received for publication July 25, 2002. Accepted for publication Aug 15, 2002. Address for reprints: Gérard Babatasi, MD, PhD, Cardiovascular Surgery Department, University Hospital, Avenue Côte de Nacre, CHU Caen, 14033 Caen cedex, France (E-mail: babatasi-g@chu-caen.fr).

The first 20% of the full text of this article appears below.

Coronary artery disease (CAD) and low ejection fraction are the most important risk factors for morbidity and mortality in patients undergoing abdominal aneurysm repair. Prior revascularization techniques have helped to decrease the risk of cardiac-related adverse events. There is, however, a subgroup of patients having both severe CAD and an acutely expanding or ruptured aneurysm that represent a therapeutic challenge.

Clinical summary

The patient was a 62-year-old man with increasing abdominal pain with posterior radiation. Computed tomographic scanning demonstrated an 8.9-cm aneurysm and a perianeurysmal hematoma (Figure 1). The patient had a history of angina. Electrocardiography (ECG) demonstrated signs of myocardial ischemia. The hemoglobin level was 11.7 g initially and decreased to 9.4 g in 3 hours. Coronary angiography (Figure 1Go) demonstrated left main coronary artery stenosis (>75%). Ejection fraction was impaired (45%). Although median sternotomy was first performed, the left internal thoracic artery (LITA) and radial artery were harvested simultaneously. No vein graft was available. Heparin (200 IU/kg) . . . [Full Text of this Article]






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