scholarly journals Multiple coronary artery perforation following global pericardial tamponade in a patient with prior coronary artery bypass graft surgery: a case report

2021 ◽  
Author(s):  
Takehiro Yamada ◽  
Takuma Aoyama
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Pericardial Tamponade ◽  
Artery Bypass Graft ◽  
Diagonal Branch ◽  
Coronary Artery Perforation

Abstract Background Patients who undergo coronary artery bypass graft surgery rarely develop global pericardial tamponade due to pericardial adhesions. There are no reports of multiple coronary artery perforations following global pericardial tamponade during percutaneous coronary intervention in these patients. Case Summary A 52-year-old male who underwent coronary artery bypass graft surgery developed effort angina pectoris. Coronary angiography demonstrated chronic total occlusion of the first diagonal branch with severe stenosis of the second diagonal branch. Because his chest pain did not improve with medical therapy and ischemia of the left ventricular anterolateral wall was confirmed by myocardial scintigraphy, percutaneous coronary intervention was performed. The second diagonal branch stenosis was passed anterogradely by a 0.014-inch coronary angioplasty guidewire, while the first diagonal branch chronic total occlusion was recanalized by side-branch intravascular ultrasonography-guided parallel wiring. After stent deployment, coronary artery perforation at the distal end of the second diagonal branch was detected via contrast injection. We immediately performed intravascular hemostasis, leading to the disappearance of contrast. However, multiple bleeding sites were visualized by angiography at different sites of coronary arteries, including the circumflex artery. Although intravascular hemostasis is a standard procedure, we could not control rebleeding. Despite intensive care, the patient died. Discussion Increased tissue pressure due to bleeding possibly led to global pericardial tamponade with multiple coronary artery perforations. We report a rare case of a patient with multiple coronary artery perforations during coronary intervention.

Coronary artery bypass graft surgery

2017 ◽  
Author(s):  
Piroze M Davierwala ◽  
Friedrich W Mohr
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Artery Bypass Graft ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

Coronary artery bypass graft surgery

2021 ◽  
pp. 565-584
Author(s):  
Piroze M Davierwala ◽  
Michael A Borger
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Artery Bypass Graft ◽  
Coronary Syndrome ◽  
Cardiac Surgeon

The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

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