We report a case of successful off-pump surgical angioplasty in the left anterior descending coronary artery using a saphenous vein patch. A 49-year-old male with left main disease and severe cerebrovascular stenosis underwent off-pump bypass to the left anterior descending artery. Postoperative angiography showed anastomotic stenosis where balloon angioplasty was performed. However, it resulted in coronary perforation complicated with epicardial tamponade, and emergency off-pump surgical angioplasty was performed. This case demonstrated that coronary arterial rupture could be managed by surgical angioplasty without cardiopulmonary bypass when coronary artery perforation occurred.
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