Maladies cardiovasculaires et diagnostic

Right Parasternal Cardiac Surgery after Radical Treatment of Left Breast Cancer

Abstract

Akimasa Morisaki, Koji Hattori, Yasuyuki Kato, Manabu Motoki, Yosuke Takahashi, Shinsuke Nishimura and Toshihiko Shibata

A 74-year-old woman required surgical treatment of severe aortic valve stenosis and two-vessel coronary artery disease consisted of a significant stenosis of the left anterior descending branch and right coronary ostium. She had previously undergone radical mastectomy and radiation therapy for left breast cancer. Severe dermal sclerosis and subcutaneous tissue defect at the chest midline, which would cause poor wound healing because of insufficient blood flow, precluded conventional median sternotomy and a left mini-thoracotomy. Therefore, we selected a hybrid treatment approach using a combination of surgery and percutaneous coronary intervention. We performed aortic valve replacement and coronary bypass grafting to the right coronary artery using a right parasternal approach followed by percutaneous coronary intervention of the left anterior descending artery on postoperative day 13. Wound healing was quite satisfactory