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Methods Our case was a 69-year-old male. He was diagnosed as myasthenia gravis a year ago and oral pyridostigmine plus corticosteroid therapy was initiated. Three months ago, he received intravenous immunoglobulin (IVIG) therapy for 5 days. Monthly repeated doses of IVIG were planned but he developed cardiac syncope. He underwent coronary angiography revealing multiple significant coronary stenoses at another institution. Transthoracic echocardiography showed an ejection fraction of 40% as consistent with ventriculography. Left ventricle was hypertrophied (left ventricular end-diastolic and en-systolic diameters were 61 and 49 mm) and interventricular septal thickness was measured as 13 mm. He was presented at our Common Council of Cardiology and Cardiovascular Surgery due to the probability of this condition to cause a contraindication for 5-day IVIG therapy. The decision was a high-risk coronary bypass surgery.

Subtotal thymectomy concomitant with emergency coronary revascularization in a myasthenia gravis case with severe left main stem stenosis