1150 A Painless Anterior Chest Wall Mass Post Coronary Artery Bypass Grafting Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Reid ◽  
F Alakhras Aljanadi ◽  
R Beattie ◽  
A Graham
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Chest Wall ◽  
Artery Bypass ◽  
Costal Cartilage ◽  
Bypass Graft ◽  
Anterior Chest Wall ◽  
Chronic Obstructive ◽  
Wall Mass ◽  
Chest Wall Mass

Abstract Aim We aim to present here a case of a painless anterior chest wall mass which was first noted during routine follow up post coronary artery bypass graft surgery Case presentation An 80-year-old male developed an asymptomatic slow growing pronounced swelling over the right anterior chest wall post CABG. His other past medical history includes chronic obstructive pulmonary disease, pulmonary fibrosis, ischaemic heart disease, an AICD for complete heart block, hypertension, hyperlipidaemia and osteoarthritis. A CT scan demonstrated a 10 x 12 x 6.5 cm subcutaneous lesion at the mid-line of the lower chest wall adjacent to the xiphisternum and the previous sternotomy site. On clinical examination there was a large non-tender cystic swelling with peripheral calcifications, but overlying skin was normal. Fluid was aspirated from the lesion and cytology showed a paucicellular specimen with features in keeping with seroma. Due to the progressive increase in size patient underwent surgical resection. A gelatinous bloody fluid was aspirated from the lesion and it was then resected enbloc. The tumour base appeared to arise from 6/7th costal cartilage and tumour was shaved away. The mass was confirmed histologically to be chondrosarcoma. Conclusions Given the uncommon prevalence of malignant primary chest wall tumours this case highlights the importance of high clinical suspicion even after developing post CABG.

Cardiovascular: Coronary Artery Bypass Graft (CABG)

2018 ◽  
pp. 197-204
Author(s):  
Alec C. Runyon ◽  
Minh Chau Joe Tran
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Management ◽  
Chronic Obstructive ◽  
Artery Bypass Graft ◽  
Obstructive Pulmonary Disease ◽  
Intraoperative Management

In this chapter the essential aspects of anesthesia for coronary artery bypass graft (CABG) surgery are discussed. Subtopics include monitoring, heparin dose, diagnosis of prolonged activated clotting time, cardiopulmonary bypass machine, and protamine administration. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include the pathophysiology of myocardial ischemia and complications due to chronic obstructive pulmonary disease and diabetes. Issues discussed related to intraoperative management include monitoring, induction, bypass considerations, and coagulation. Postoperative concerns discussed include ICU transfer of care and postoperative management.

scholarly journals Contribution of Current Comorbid Conditions to Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass and Stroke Distribution in Carotid Artery Stenosis Groups

2021 ◽  
Vol 24 (4) ◽  
pp. E724-E730
Author(s):  
Mehmet Işık ◽  
Yusuf Velioğlu
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Coronary Artery Bypass ◽  
Carotid Artery Stenosis ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Stenosis ◽  
Chronic Obstructive ◽  
Large Populations ◽  
Comorbid Diseases

Objective: The aim of this study was to contribute to the issue of “Who should we perform Doppler ultrasonography on?” and determine the contribution of comorbid diseases to the development of carotid artery stenosis (CAS) and preoperative CAS by examining comorbid diseases in patients undergoing coronary artery bypass graft operation (CABG) and also discussing the effect of carotid stenosis levels on postoperative stroke. Method: Between 2011-2015, a total of 921 patients who underwent cardiac surgery retrospectively were examined. Of these, 594 CABG patients aged 60 and over who underwent preoperative carotid Doppler examination were analyzed. Results: Sixty-five percent of patients were male, and 35% were female. The mean age was 69.3 years. Sixty-nine percent of patients were in the 0-29% stenosis group, 12.9% in the 30-49% group, 14.6% in the 50-69% group, 3% in the 70-99% group, and 0.3% in the 100% occlusion group. Peripheral artery disease (PAD), age, gender, and diabetes mellitus (DM) were found to have significant (P < 0.05) effects on the occurrence of CAS. CAS increased by 0.9% with an increase of one year in age, 10.8% with the presence of PAD, 3% with male sex, 3.8% with presence of chronic obstructive pulmonery disease (COPD), 1.9% with presence of left main coronary disease (LMCAD), and 0.9% with presence of hypertension. In the decision tree analysis, the rate of 50% and above CAS in the presence of PAH + DM and age older than 65 years was 62.5%. Cerebrovascular accident (CVA) distribution was 2.1% in the 0-29% group, 2.5% in the 30-49% group, 4.5% in the 50-69% group, and 11.1% in the 70-99% group. Postoperative CVA was not observed in 10 patients who underwent carotid endarterectomy (CE). Postoperative CVA developed in six patients with 50% or more stenosis who did not undergo CE. Conclusion: For the preoperative detection of CAS in patients undergoing CABG, the association of advanced age, PAD, DM, male gender, COPD, LMCAD, and hypertension risk factors should be considered. We suggest that carotid screening should be performed in those over 65 years of age and with PAD+DM. Studies with large populations are needed to observe the effects of aortic atherosclerosis load, surgical procedure, and unilateral/bilateral CAS presence on the development of stroke in patients with severe CAS and postoperative CVA.

scholarly journals Preoperative preparation of patients with coronary artery disease and comorbidity of chronic obstructive lung disease to scheduled coronary artery bypass graft surgery

2018 ◽  
Vol 28 (3) ◽  
pp. 263-271
Author(s):  
E. D. Bazdyrev ◽  
O. M. Polikutina ◽  
Yu. S. Slepynina ◽  
S. A. Pomeshkina ◽  
E. A. Vegner ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Chronic Obstructive ◽  
Artery Bypass Graft ◽  
Artery Disease

We aimed to assess an impact of different prehabilitation schemes on a risk of postoperative cardiorespiratory complications after coronary artery bypass graft surgery (CABG) in patients with coronary artery disease (CAD) and comorbid chronic obstructive pulmonary disease (COPD). Methods. Two groups of patients with CAD and comorbid COPD who were planned for CABG were recruited in the study using the pairwise testing. A criterion of difference was the treatment with tiotropium/olodaterol (Tio/Olo) as one of prehabilitation components. An occurrence of postoperative cardiorespiratory complications was analyzed according to prehabilitation schemes used. Results. The patients with CAD + COPD treated with Tio/Olo during 12.4 ± 5.4 days prior to CABG surgery demonstrated improvement in clinical and laboratory parameters characterizing the severity of COPD just before surgical coronary revascularization. A risk of postoperative cardiovascular and respiratory complications was higher in patients not receiving bronchodilator therapy before the surgery. 

scholarly journals Near-fatal kinking of mammary graft due to emphysematous lung disease

2018 ◽  
Vol 6 ◽  
pp. 2050313X1876722
Author(s):  
John T Denny ◽  
Sagar Mungekar ◽  
Benjamin R Landgraf ◽  
Valerie A McRae ◽  
Sajjad Ibrar ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Chronic Obstructive ◽  
Artery Bypass Graft ◽  
Internal Mammary

Left internal mammary artery grafting is commonly used in elective coronary artery bypass graft surgery. We report a near-fatal case with graft kinking upon sternal closure due to distended, emphysematous lungs impinging on the mammary graft. After the sternum was closed, the patient suffered a severe hemodynamic deterioration. Surgical examination revealed kinking of his left internal mammary artery upon sternal closure due to distended, emphysematous lungs impinging on the mammary graft. Using an off-bypass technique, the kink in the mammary graft to the left anterior descending artery was removed by moving the origin of the left internal mammary artery to a hooded graft of a saphenous vein graft instead. In this position, the graft no longer was impinged upon by the distended emphysematous lungs. Subsequently, the patient’s sternum was closed without hemodynamic impingement. Although chronic obstructive pulmonary disease is well described to increase complications in coronary artery bypass graft surgery, it has not been previously associated with the kinking of a left internal mammary artery. This report highlights another contribution that chronic obstructive pulmonary disease can make to increased morbidity following coronary artery bypass graft surgery and alerts readers to watch for this complication in susceptible patients.

Noninvasive Follow-Up of Coronary Artery Bypass Graft Patency Using Multi-Slice Computed Tomography

2006 ◽  
Vol 55 (5) ◽  
pp. 451
Author(s):  
Seung Ho Joo ◽  
Byoung Wook Choi ◽  
Jae Seung Seo ◽  
Young Jin Kim ◽  
Tae Hoon Kim ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Patency ◽  
Artery Bypass Graft

Assessment of the Radial Artery and Hand Circulation by Computed Tomography Angiography: A Pilot Study

2005 ◽  
Vol 8 (1) ◽  
pp. 28 ◽  
Author(s):  
Omer Faruk Dogan ◽  
Musturay Karcaaltincaba ◽  
Umit Duman ◽  
Deniz Akata ◽  
Aytekin Besim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Radial Artery ◽  
Anatomic Variation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Preoperative Imaging ◽  
Median Artery ◽  
Test Result

Objectives: The radial artery (RA) is increasingly being used as a coronary bypass graft. Results of a previous study using Doppler ultrasound and histopathologic examinations indicated that the RA has a higher incidence of preexisting intimal hyperplasia, medial calcification, and atherosclerosis than the internal thoracic artery. The aims of this study were to evaluate the use of computed tomographic angiography (CTA) to display hand collateral circulation, to define the criteria for an abnormal CTA test result, and to demonstrate usefulness of CTA as an alternative to conventional angiography for evaluation of the radial artery. Materials and Methods: Sixteen patients scheduled for coronary artery bypass grafting entered this study. We performed 32 examinations of forearm and hand arterial anatomy in these patients. CTA was performed in patients with a normal Allen test result, except 1 patient who had a persistent median artery. Soft tissue density forehand roentgenography was performed in all patients before the CTA evaluation. There was no selection of patients in relation to patient characteristics. As a risk factor for radial artery calcification, 6 of the patients had diabetes mellitus, 6 had aortofemoral occlusive disease, and 4 had a history of smoking. Results: Bilateral forearm arteries were visualized in all patients. Severe RA calcification was found in 1 patient, and distal occlusion was found in another patient. Focal RA calcification was noted in 2 patients. In the remaining patients no radial artery calcification or occlusion was noted. Anatomic variation of the upper limb arteries was shown in 2 patients; these variations were persistent median artery with absence of the radial and ulnar arteries and high bifurcation of the radial artery from the brachial artery. Conclusion: CTA is useful and safe for detection of radial artery calcific disease and assessment of the forehand circulation and its anatomic variations. Preoperative imaging of the RA is a means to avoid unnecessary forearm exploration or inadvertent use of a diseased conduit in coronary artery bypass candidates with multiple risk factors such as diabetes mellitus.

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