Simultaneous off-pump coronary artery bypass grafting (CABG) and right upper lobectomy for critical left anterior descending artery (LAD) stenosis and aspergilloma

A 58 years old man with a history of ischemic heart disease presented with massive hemoptysis. On evaluation with CT chest, he was found to have a large aspergilloma in the left upper lobe. Coronary angiogram was also performed for increasing episodes of angina which showed critical 100% ostial left anterior descending (LAD) stenosis. In view of aspergilloma and hemoptysis, patient could not have conventional open heart surgery and heparinization. Therefore, coronary artery bypass grafting (CABG) was performed on beating heart and this was followed by left upper lobectomy at the same time. Patient had an uneventful post-operative course.