Ann Thorac Surg 2008;86:314. doi:10.1016/j.athoracsur.2007.07.003
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Mismatch Between Angiographic Result and Surgical Evidence
Nicola Vistarini, MD,
Stéphane Aubert, MD*,
Iradj Gandjbakhch, MD
Thoracic and Cardiovascular Surgery Department, Pierre and Marie Curie University, Department of Thoracic and Cardiovascular Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
* Address correspondence to Dr Aubert, Thoracic and Cardiovascular Surgery Department, Pitié Salpêtrière Hospital, 47-83 boulevard de l'hôpital, Paris, 75013, France (Email: stephaneaubert{at}yahoo.fr).
A 53-year-old man with a history of multiple stents (n = 3) in the left anterior descending coronary artery (LAD) presented with atypical chest pain. Coronary angiography was performed showing a satisfactory result on the stented LAD, revealing an aneurysm of its distal part, just after the last stent, followed by a significant stenosis (Fig 1). The patient was operated on through a median sternotomy and under cardiopulmonary bypass. The LAD was opened from the distal stenosis to the proximal stent and an extensive endarterectomy was performed (Figs 2A–2D). The removed material was a thick block of atherosclerosis mixed with stents and inflammatory reaction tissue (Fig 3). The LAD aneurysm was also opened (Fig 2C, indicated by the coronary probe) and all diagonal branches were preserved during endarterectomy. A wide patch anastomosis was performed using the left internal mammary artery and the LAD aneurysm was excluded with the suture. The postoperative course was uneventful and the patient was discharged on postoperative day 6. The case illustrates the fact that angiograms can be misleading, that stents produce an intense inflammatory reaction in some patients, and that endarterectomy operations can be done successfully (at least for the short term) for these patients.
