Long Segmenter Reconstruction of Diffusely Diseased of the Left Anterior Descending Artery without Coronary Artery Bypass Grafting

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%.