Coronary Bypass Surgery in Patients with Previous Pneumonectomy

Introduction: Severe pulmonary dysfunction is a commonly occurring postoperative complication following cardiac surgery. Resection of lung causes major anatomical and physiological changes. Shift the mediastinum reduction in respiratory function pneumonectomy makes surgery challenging not only for surgeon but also anaesthetist. The reported experience sparse patients with prior who are undergoing ischemic or valvular heart disease.
 We report case to highlight certain important features that we think while managing these patients.
 Case Presentation: patient was 56-year male had undergone extra-pericardial 30 years earlier tuberculosis left lung. Echocardiography showed ventricular 50%. His coronary angiogram revealed severe triple vessle disease. Preoperative spirometry FVC 1.94 L (52% predicted), FEV1 1.3 (48% FEV1/FVC ratio 70%. pre-operative workup this included computerised tomography chest assess distortion intra-thoracic anatomy. In an attempt improve admitted 10 days intensive physiotherapy incentive spirometry. He underwent artery bypass grafting (CABG) using cardiopulmonary antegrade cold blood cardioplegia. Internal thoracic used graft anterior descending (LAD), saphenous vein (SVG) posterolateral branch right artery, first diagonal frist obtuse marginal arteries. Access arteries circumflex region difficult due shift side. weaned from ventilator 14 hours after CPAP helmet immediately applied period 48 continuosly. After on it at intervals 5 days. subsequent recovery slow progressive discharged 11th day good conditions.
 Conclusion: conclude attention specific preoperative, intraoperative, management, open procedures can be performed successfully pneumonectomy.