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Michael C. Murphy
Nicholas T. Kouchoukos
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J Thorac Cardiovasc Surg 2010;140:719-720
© 2010 The American Association for Thoracic Surgery

Brief Technique Report

Aortic valve replacement and coronary artery bypass via left anterior thoracotomy after previous left pneumonectomy

Sotiris C. Stamou, MD*, Michael C. Murphy, MD, Nicholas T. Kouchoukos, MD*

Division of Thoracic and Cardiovascular Surgery, Missouri Baptist Medical Center, St Louis, Mo

Received for publication December 23, 2009; accepted for publication January 3, 2010.

* Address for reprints: Nicholas T. Kouchoukos, MD, 3009 N. Ballas Road, Suite 266C, St Louis, MO 63131. (Email: cvsisfun@hotmail.com; NTKouch@aol.com).

* Sotiris C. Stamou, MD, 1315 Whispering Pines Dr, Apt L, St Louis, MO 63146. (Email: cvsisfun@hotmail.com; NTKouch@aol.com).

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


   Introduction
 
Left anterior thoracotomy is an infrequent approach to perform open cardiac operations. It has been used for coronary artery bypass grafting (CABG) and rarely for valvular procedures.1-4Go We describe a left anterior thoracotomy approach for combined aortic valve replacement (AVR) and myocardial revascularization in a patient with a marked shift of mediastinal structures after previous left pneumonectomy.


   Clinical Summary
 
An 83-year-old man presented with frequent episodes of chest pain and shortness of breath. He had undergone a left pneumonectomy for a T4 N2 M1 poorly differentiated adenocarcinoma of the left lung 8 years previously and subsequent stenting of the left anterior descending and circumflex coronary arteries. Transthoracic echocardiography and cardiac catheterization demonstrated severe stenosis of the left main and right coronary arteries, severe aortic stenosis, and moderate aortic regurgitation. Computed tomography of the chest revealed marked displacement of mediastinal structures into the left side of the chest . . . [Full Text of this Article]






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