First coronary artery bypasss surgery in VietNam for an obese congenital dwarfism
A coronary artery bypass surgery was successfully conducted on a 55-year old man with leaky heart valves and coronary artery stenosis
This patient from Nam Dinh Province was admitted to Viet Duc University Hospital for a dyspnea for about 2 months. With the diagnosis of severe leaky heart valves in combination with coronary artery stenosis, the surgical indication was made.
Dr. VU Ngoc Tu, Cardiac and Thoracic Center, Viet Duc University Hospital shared that patient’s cardiac condition was not so severe and a mitral valve repair combined with coronary bypass was expected. For the bypass, the saphenous vein or radial artery or internal mammary artery behind the sternum could be used. It is considered as routine intervention for most of patients with heart valves and coronary artery disorders.
However, as an obese congenital dwarfism with only 120 cm of height and 60 kg of weight (BMI = 41.7 in comparison with about 22 in normal person), this case was exceptional. The obesity impeded his extremities to support his body so he was unable to move by himself. The health status of patient predicted the movement problem could occur and affect directly to the post-operative recovery.
Dr. Tu said that the surgical decision met a lot of difficulties, especially about materials used to conduct the coronary artery bypass. His short arms and legs with thick subcutaneous fat made it impossible to take vessels off. Beside, the deformed sternum made us impossible to remove the internal mammary artery for making a bridge as other patients.
To solve all above problems, the surgical team of Viet Duc University Hospital had a creative but daring decision to remove the saphenous vein from patient’s son. This was the only solution about material for coronary artery bypass but it had never been performed in Vietnam.
Another trouble was that the expected bypass position at ascending aorta was with multiple heavy calcification, a rare condition in a normal 55-year old man. Therefore, during operation, it is required to use every millimeter of the artery with less calcification possible to perform the bypass because if the anastomosis was performed on the calcified area, it might lead to life-threatening complications locally at the thoracic aorta and systematically by moving calcification or sclerosis up, causing cerebral infarction, and the patient might die immediately during the operation.
Two surgical teams worked at the same time smoothly. The 1st team took bilateral saphenous veins off from patient’s son and brought to the 2nd team who has already explored the patient’s heart. Heart valve repair was conducted at the same time with coronary artery bypass. After a 4-hour operation, the patient’s heart recovered well.
The post-operative recovery was favorable. After 1 week, patient recovered almost completely and could eat and self-care like a normal person. Cardiac ultrasound check and all blood tests results were good.
Lê Nga / Vnexpress Newspaper