EMERGENCY CORONARY ARTERY BYPASS GRAFTING VIA LEFT ANTERIOR SMALL THORACOTOMY WITHOUT CARDIOPULMONARY BYPASS FOR UNSTABLE ANGINA WITH SYSTEMIC LUPUS ERYTHEMATOSUS-A CASE REPORT-

Abstract

We report a case of emergency coronary artery bypass grafting via a left anterior small thoracotomy (LAST) without cardiopulmonary bypass for unstable angina with systemic lupus erythematosus (SLE). A 72-year-old woman was admitted for severe angina pectoris. She had an 18 year-history of steroid treatment for SLE. Coronary angiography revealed the causative lesion in the left anterior descending artery (LAD) seg. 6, just proximal with 95% stenosis. We were apprehensive about catheter intervention for this stenotic lesion due to the high risk possibile left main trunk injury, and chose coronary artery bypass grafting. We selected LAST as the surgical procedure without cardiopulmonary bypass, in consideration of several factors: she had bilateral lower limb vascular disease, other organs'conditions were unknown, her advanced age and her lack of daily activity. The left internal thoracic artery (LITA) was anastomosed to the LAD seg. 8 under beating heart conditions. The operation was without complication, the post-operative course was satisfactory, and supplemental steroid administration was not required. Postoperative angiography showed the LITA graft had good patency with no stenosis. In conclusion LAST procedure without cardiopulmonary bypass can be considered a useful technique for treating a patient with SLE on an emergency basis.