Abstract
A 57-year-old man with ocular myasthenia gravis was admitted to our hospital because of acute respiratory insufficiency associated with myasthenic crisis. He had a history of unstable angina indicated percutaneous coronary artery angioplasty. He was diagnosed with generalized nonthymomatous myasthenia gravis and a triple vessel coronary artery disease. We conducted a simultaneous surgical intervention, including extended thymectomy and coronary artery bypass grafting, using a standard cardiopulmonary bypass via median sternotomy. The patient had already been immunocompromised at surgery for having diabetes, and postoperative long-term steroid therapy. In this rare and special condition, a meticulous overall therapeutic strategy was needed in order to avoid myasthenic crisis and prepare for the worst case scenario of mediastinitis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Danton MH, Anikin VA, McManus KG, McGuigan JA, Gampalani G. Simultaneous cardiac surgery with pulmonary resection: Presentation of series and review of literature. Eur J Cardiothorac Surg 1998; 13: 667–72.
Ishimura H, Sata T, Matsumoto T, Takizuka A, Shigematsu A. Anesthetic management of a patient with myasthenia gravis during hypothermic cardiopulmonary bypass. J Clin Anesth 1998; 10: 228–31.
Hayashida N, Kawara T, Akasu K, Kai E, Kosuga T, Chihara S, et al. Coronary artery bypass surgery in a patient with myasthenia gravis. Kurume Med J 2000; 47: 173–5.
Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revasculization with or without cardiopulmonary bypass. Ann Thorac Surg 2000; 69: 1198–204.
Sabik JF, Gillinov AM, Blackstone EH, Vacha C, Houghtaling PL, Navia J, et al. Does off-pump coronary surgery reduce morbidity and mortality? J Thorac Cardiovasc Surg 2002; 124: 698–707.
d’Empaire G, Hoaglin DC, Perlo VP, Pontoppidan H. Effect of prethymectomy plasma exchange on postoperative respiratory function in myasthenia gravis. J Thorac Cardiovasc Surg 1985; 89: 592–6.
Yeh JH, Chiu HC. Comparison between double-filtration plasmapheresis and immunoadsorption plasmapheresis in the treatment of patient with myasthenia gravis. J Neurol 2000; 247: 510–3.
Borger MA, Rao V, Weisel RD, Ivanov J, Cohen G, Scully HE, et al. Deep sternal wound infection: Risk factors and outcomes. Ann Thorac Surg 1998; 65: 1050–6.
Matsa M, Paz Y, Gurevitch J, Shapira I, Kramer A, Pevny D, et al. Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus. J Thorac Cardiovasc Surg 2001; 121: 668–74.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Asai, K., Suzuki, K., Washiyama, N. et al. Combined operation for myasthenia gravis and coronary artery disease. Jpn J Thorac Caridovasc Surg 52, 65–67 (2004). https://doi.org/10.1007/s11748-004-0085-0
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s11748-004-0085-0