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J Thorac Cardiovasc Surg 2005;129:1434-1435
© 2005 The American Association for Thoracic Surgery

Brief Communication

Infrarenal abdominal aortic aneurysm rupture and severe symptomatic coronary artery disease: Rapid combined transdiaphragmatic off-pump coronary surgery and abdominal aortic aneurysm repair

Georges Fayad, MDa,*, Thomas Modine, MDa, Stephan Haulon, MDb, Christophe Decoene, MDa, Richard Azzaoui, MDa, Reza Salari, MDb, Mohamed Koussa, MDb

a Department of Cardiovascular Pr Warembourg, Hôpital Cardiologique, CHRU de Lille, Lille, France.
b Vascular Surgery, Hôpital Cardiologique, CHRU de Lille, Lille, France.

Received for publication October 7, 2004; accepted for publication October 21, 2004.

* Address for reprints: Georges Fayad, MD, Hôpital Cardiologique, CHRU, Boulevard du Pr. J. Leclercq, 59037 Lille Cedex, France (Email: g-fayad@chru-lille.fr).

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

The incidence of severe coronary disease in patients with abdominal aortic aneurysms (AAAs) is about 30%. Impaired myocardial performance in patients undergoing vascular reconstruction is the first cause of morbidity and mortality, especially in cases of ruptured AAA. Coronary revascularization is often not performed because of the necessity of a rapid aortic reconstruction. We describe a rapid combined aortic and coronary procedure to reduce postoperative cardiac events.

Clinical Summary

A 76-year-old man who had thoracic pain at rest and an 85-mm maximum diameter infrarenal AAA on helical computed tomography underwent a cardiac evaluation. Echocardiography revealed a 35% ejection fraction, together with inferior hypokinesia. A thallium myocardial scintigraphy depicted severe inferior ischemia. Coronary angiogram revealed a normal left coronary network and a very tight stenotic lesion of the midright coronary artery (Figure 1, A). An angioplasty was attempted . . . [Full Text of this Article]






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