Abstract
Here we present two cases in which hypertrophic aortic branches caused trouble during minimally invasive cardiac surgery. We performed mitral valvuloplasty with the Maze procedure in Case 1 and mitral valvuloplasty with aortic valve replacement in Case 2 via mini-thoracotomy. In preoperative computed tomography scan, we did not note a hypertrophic bronchial artery in Case 1 or a dilated intercostal artery in Case 2. The right atrium was distended after aortic cross-clamping and perioperative myocardial infarction occurred in Case 1. Whereas, we could effectively deal with this situation in Case 2. The increased pulmonary blood flow can potentially cause critical problems during minimally invasive surgery. Sufficient venting of the right ventricle and secure myocardial protection is the key to perform safe surgery in the presence of dilated aortic branches. However, surgeons should not hesitate to convert to sternotomy under poor surgical exposure despite sufficient venting.
Similar content being viewed by others
References
McGoon DC, Baird DK, Davis GD. Surgical management of large bronchial collateral arteries with pulmonary stenosis or atresia. Circulation. 1975;52:109–18.
Hiraoka A, Nakajima K, Kuinose M, Totsugawa T, Yoshitaka H. Initial large-dose administration of modified St. Thomas’ solution. Asian Cardiovasc Thorac Ann. 2014;22:267–71.
Do KH, Goo JM, Im JG, Kim KW, Chung JW, Park JH. Systemic arterial supply to the lungs in adults: spiral CT findings. Radiographics. 2001;21:387–402.
Grosse C, Grosse A. CT findings in diseases associated with pulmonary hypertension: a current review. Radiographics. 2010;30:1753–77.
Soto B, Kassner EG, Baxley WA, editors. Congenital obstructing lesions. In: Imaging of cardiac disorders, vol. 1. Congenital disorders. New York: Gower Medical Publishing; 1992. p. 178–201.
Wang X, Nie SP. The coronary slow flow phenomenon: characteristics, mechanisms and implications. Cardiovasc Diagn Ther. 2011;1:37–43.
Acknowledgments
We gratefully acknowledge the radiological counsel of Dr. Masatoshi Tsunoda and Dr. Hisashi Sugimoto, Department of Radiology, The Sakakibara Heart Institute of Okayama.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to declare.
Rights and permissions
About this article
Cite this article
Totsugawa, T., Sakaguchi, T., Hiraoka, A. et al. Hypertrophic aortic branches can potentially cause critical problems during minimally invasive cardiac surgery. Gen Thorac Cardiovasc Surg 64, 10–13 (2016). https://doi.org/10.1007/s11748-015-0597-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-015-0597-9