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April 18, 2026Surgical Case ReportsOpen Access

Proactive CABG for left main-adjacent cardiac paraganglioma enables complete resection and preserves coronary perfusion.

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Why the study?

Cardiac paragangliomas adjacent to the left main coronary trunk pose a major surgical dilemma in achieving complete oncologic excision while preserving coronary perfusion and controlling bleeding.

Design

Case report

Key result

Proactive coronary artery bypass grafting before en bloc resection of a left main coronary trunk-adjacent functional cardiac paraganglioma enabled complete tumor excision and preserved coronary perfusion.

Authors

KMKenichi MorimotoYKYuichiro KishimotoTOTakeshi Onohara

Discussion

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Overview

Requires advanced planning for radical excision with coronary preservation near the LMT; hypothesis-generating for rare cardiac paragangliomas.

Key Points

  • The aim is to explore effective surgical strategies for excising a cardiac paraganglioma located near the left main coronary trunk.
  • Case report of a surgical intervention performed on a cardiac paraganglioma
  • Proactive coronary artery bypass grafting (CABG) was employed to manage coronary perfusion concerns
  • Complete excision of the tumor was attempted to ensure oncologic radicality
  • Successful excision of the cardiac paraganglioma was achieved
  • Coronary artery perfusion was maintained post-operation
  • No major complications were observed related to bleeding or heart function

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P
Population
1 33-year-old man with episodic postprandial chest/abdominal pain, paroxysmal hypertension, and cold sweating, diagnosed with a functional cardiac paraganglioma adjacent to the left main coronary trunk (LMT).
I
Intervention
Preoperative doxazosin followed by proactive coronary artery bypass grafting (CABG) using saphenous vein grafts to the LAD and PL branch, and en bloc resection of the tumor including part of the left atrial roof with bovine pericardial patch reconstruction.
O
Outcome
Complete tumor resection and preservation of coronary perfusion

Proactive coronary artery bypass grafting before tumor manipulation can provide a myocardial safety net enabling complete en bloc resection of functional cardiac paragangliomas adjacent to the left main coronary trunk.

Limitations

  • As a single case, generalizability is limited
  • The need for planned revascularization, graft targets, and the extent of exposure should be individualized according to tumor-coronary anatomy and the degree of invasion

Cite This Study

Morimoto et al. (2026) conducted a case report in Functional cardiac paraganglioma (n=1). Proactive coronary artery bypass grafting and en bloc resection was evaluated on Complete tumor resection (R0) and survival. Proactive coronary artery bypass grafting before en bloc resection of a left main coronary trunk-adjacent functional cardiac paraganglioma enabled complete tumor excision and preserved coronary perfusion.

synapsesocial.com/papers/69e31f1a40886becb653e9e5https://doi.org/10.70352/scrj.cr.26-0056
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