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Ann Thorac Surg 2004;77:718-720
© 2004 The Society of Thoracic Surgeons

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Case report

Aortic valve replacement in a patient with a patent internal thoracic artery graft

^a Department of Surgery III, Nara Medical University, Nara, Japan

Accepted for publication April 9, 2003.

^* Address reprint requests to Dr Ueda, Department of Surgery III, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
e-mail: u-taka{at}naramed-u.ac.jp

Myocardial protection in patients requiring a second open-heart surgical procedure after coronary artery bypass grafting, especially when there is a patent left internal thoracic artery graft to the left anterior descending coronary artery, remains controversial. We present the case of a patient in whom aortic valve replacement was undertaken 18 months after coronary artery revascularization. Unusual features included beating-heart aortic valve replacement with continuous retrograde coronary sinus perfusion and avoidance of dissection of the patent grafts, including the left internal thoracic artery and a saphenous vein graft.

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