What is the clinical evidence from this study?

Study design: Case Report. Population: Functional cardiac paraganglioma (n=1). Intervention: Proactive coronary artery bypass grafting and en bloc resection. Primary outcome: Complete tumor resection (R0) and survival.

What does this research mean for the field?

Proactive coronary artery bypass grafting before en bloc resection of a left main coronary trunk-adjacent functional cardiac paraganglioma enables complete tumor excision while preserving coronary perfusion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe a surgical strategy that reconciles oncologic radicality with the preservation of coronary perfusion during resection of a functional cardiac paraganglioma adjacent to the left main coronary trunk.

April 18, 2026Surgical Case ReportsOpen Access

Surgical Management of a Left Main Coronary Trunk-Adjacent Functional Cardiac Paraganglioma Using Proactive Coronary Artery Bypass Grafting: A Case Report

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Key result

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

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

Authors

KMKenichi MorimotoTottori University YKYuichiro KishimotoTottori University TOTakeshi OnoharaTottori University

Discussion

Member takes

Implication

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

Key Points

To describe a surgical strategy that reconciles oncologic radicality with the preservation of coronary perfusion during resection of a functional cardiac paraganglioma adjacent to the left main coronary trunk.
Saphenous vein bypass grafts were proactively constructed on an on-pump beating-heart platform prior to cardioplegic arrest as a myocardial protection safety net.
Operative exposure was achieved via transection of the ascending aorta and main pulmonary artery under cardioplegic arrest, enabling en bloc excision with partial left atrial wall resection.
The left main coronary trunk and left anterior descending artery were anatomically preserved, permitting ligation of the redundant coronary graft after confirming native perfusion.
Histopathology confirmed left atrial wall infiltration with a Ki-67 labeling index of 12.2%, a GAPP score of 5 points, and loss of SDHB expression.
Diffuse perioperative bleeding and reperfusion ventricular arrhythmias required temporary peripheral venoarterial extracorporeal membrane oxygenation, leading to hemodynamic recovery and catecholamine normalization.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

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).

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.

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/69e31f1a40886becb653e9e5 https://doi.org/10.70352/scrj.cr.26-0056

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April 18, 2026Surgical Case ReportsOpen Access

Surgical Management of a Left Main Coronary Trunk-Adjacent Functional Cardiac Paraganglioma Using Proactive Coronary Artery Bypass Grafting: A Case Report

View Full Paper

Ask AI

Bookmark

Key result

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

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

Authors

KMKenichi MorimotoTottori University YKYuichiro KishimotoTottori University TOTakeshi OnoharaTottori University

Discussion

Member takes

Implication

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

Key Points

To describe a surgical strategy that reconciles oncologic radicality with the preservation of coronary perfusion during resection of a functional cardiac paraganglioma adjacent to the left main coronary trunk.
Saphenous vein bypass grafts were proactively constructed on an on-pump beating-heart platform prior to cardioplegic arrest as a myocardial protection safety net.
Operative exposure was achieved via transection of the ascending aorta and main pulmonary artery under cardioplegic arrest, enabling en bloc excision with partial left atrial wall resection.
The left main coronary trunk and left anterior descending artery were anatomically preserved, permitting ligation of the redundant coronary graft after confirming native perfusion.
Histopathology confirmed left atrial wall infiltration with a Ki-67 labeling index of 12.2%, a GAPP score of 5 points, and loss of SDHB expression.
Diffuse perioperative bleeding and reperfusion ventricular arrhythmias required temporary peripheral venoarterial extracorporeal membrane oxygenation, leading to hemodynamic recovery and catecholamine normalization.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

Intervention

Outcome

Complete tumor resection and preservation of coronary perfusion

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

synapsesocial.com/papers/69e31f1a40886becb653e9e5 https://doi.org/10.70352/scrj.cr.26-0056

Also Consider

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