Simultaneous Repair of the Aneurysm of the Descending Aorta with Off-pump Coronary Artery Bypass Grafting

infarction and thrombosis of the lower extremities was reported. The patient had undergone repair of aneurysm of the aortic arch four years previously, in addition to repair of aneurysm of abdominal aorta seven years previously. He was conscious with a blood pressure of 200/120 mmHg in the right arm. Computed tomography with contrast medium revealed the aneurysm of the descending aorta with a dilatation 6 cm in diameter, which had the intramural hematoma (Fig. 1). Magnetic resonance angiography (MRA) also indicated the aneurysm of the descending aorta just above the level of the diaphragm (Fig. 2). Electrocardiography revealed ST depression in I, V5, and V6, and Q waves in II, III, and aVF. Coronary angiography revealed significant (75%) stenosis of the left anterior descending artery (LAD) and occlusion of the right coronary artery (RCA). The left internal thoracic artery (LITA) was not diseased entirely. Dipyridamole myocardial perfusion imaging test revealed ischemia in the region of the LAD and infarction in the area of the RCA. Myocardium only in the LAD region remained viable. Combined repair of the aneurysm of the descending aorta and CABG (LITA to LAD) was required because of the higher risk of rupture of the aortic aneurysm. Off-pump Section of Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan Received March 11, 2004 Accepted July 28, 2004 Introduction