TITLE:
Long Segmenter Reconstruction of Diffusely Diseased of the Left Anterior Descending Artery without Coronary Artery Bypass Grafting
AUTHORS:
Salih Fehmi Katırcıoğlu, Hasan Attila Keskin
KEYWORDS:
Coronary Artery Disease, LAD Endarterectomy
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.12 No.3,
March
11,
2022
ABSTRACT: A
58-year-old male patient with LAD diffuse had hyperlipidemia and hypertension.
Preoperative angiography showed that he had triple-vessel disease with
diffusely diseased LAD. In echocardiography, EF was detected as 60 % (52 - 70) and PAP 25 (12 - 25)
mmHg and 2 degrees of tricuspid insufficiency. In this case report, we will present our LAD
endarterectomy case. Surgical technique: after standard general anesthesia,
cardiopulmonary bypass procedure and moderate hypothermia, cold cardioplegic
arrest. Longitudinal long LAD endarterectomy
was performed (approximately 10 cm long). A dissector was used to develop on the plane between media and
atheroma. Gentle traction was made to light off the atheroplaque with the
coronary artery branches, distal and
proximal part of the LAD. We assumed that the distal
part of the LAD was free from plaque. Then we made the same
procedure to the proximal part of the LAD. Luckily, we observed that proximal atheroplaque was also harvested. After completing the endarterectomy,
antegrade cardioplegia was administrated to wash and any debris is LAD; also we tried the distal part of the
LAD. Via retrograde cardioplegia administrated, we
did also observe the bolus return of cardioplegia via retrograde way.
After making the same coronary end arteriotomy was
successful, we used saphenous vein as a patch for LAD reconstruction. We made only patch plasty like
a carotid endarterectomy. Posto- perative follow-up period was 120 months. According to 8 years angiography result, LAD patch plasty was
working relatively well. The patient did not have any complaints. We made coronary angiography 10 years after the operation
and observed that our patch plasty was occluded but the patient has still class II symptoms
with an EF value of 40%.