Left Anterior Descending Coronary Artery Aneurysm Excision

This video demonstrates a left anterior descending coronary artery aneurysm excision and the removal of a previously placed stent in a 64-year-old man with diabetes.

After standard midline sternotomy, adhesions were found between the aneurysmal sac, the chest wall, and the surrounding tissue. Adhesiolysis was done using blunt and sharp dissection. A previous vein graft from the aorta to the obtuse marginal artery was dissected and looped, and the left internal mammary artery was dissected. The left anterior descending artery (LAD) aneurysmal sac was opened, and clots were removed. The previously placed LAD stent was retrieved. Posterior to the LAD there was another sac, which was opened and clots were removed. The proximal and distal ends of the LAD were identified and closed using pericardial felt. The inner aneurysmal sac’s cavity was obliterated with surgical glue, and the opening was closed using bovine pericardium in a double layer continuous manner. The outer aneurysmal sac was closed using pericardial felt in a double layer continuous manner.

Distal to the sac, an LAD arteriotomy was performed and a 1.5 mm shunt was inserted. The distal end of the vein conduit to be grafted was anastomosed to the LAD using a prolene 8-0 suture in a continuous manner. Cross-clamp was removed and the proximal anastomosis of the vein graft was completed using a prolene 6-0 suture (13mm) in a continuous manner. The overall contractility of the heart was noted to be improved.

Suggested Reading

1. Okamura K, Suematsu Y, Morizumi S, Kawata M. Coronary artery aneurysm occuring very late after drug-eluting stent implantation. Interact Cardiovasc Thorac Surg. 2014 Dec:19(6):1068-1070.