scholarly journals Recurrent Chylous Ascites Leading to Transudative Chylothorax Due to Bi-Ventricular Heart Failure

2021 ◽  
Vol 9 ◽  
pp. 232470962110261
Author(s):  
Tuong Vi Cassandra Do ◽  
Justin Cozza ◽  
Shyam Ganti ◽  
Jayaramakrishna Depa
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Chronic Kidney Disease Stage ◽  
Bypass Graft ◽  
Chylous Ascites ◽  
Lower Extremities ◽  
Disease Status ◽  
Disease Stage ◽  
Chronic Obstructive

Chylothorax is a pleural effusion of >110 mg/dL of triglycerides with a milky appearance with transudative being rare. In this article, we present a case of transudative chylothorax with concurrent chylous ascites that is secondary to congestive heart failure (CHF). A 70-year-old male with CHF with ejection fraction of 10%, coronary artery disease status post coronary artery bypass graft, sleep apnea, chronic kidney disease stage 3, and chronic obstructive pulmonary disease presented with worsening abdominal distention, shortness of breath, and increased lower extremities edema. He denied any cough or fever but had orthopnea and paroxysmal nocturnal dyspnea. He requires monthly paracentesis with drainage of 5 to 9 L each time. On physical examination, he had crackles bilaterally with no wheezes or jugular venous distension. His cardiac examination was unremarkable. He did have abdominal distension with dullness to percussion and a positive fluid wave. There was +2 bilateral pitting edema of lower extremities. He had a diagnostic paracentesis where 9.2 L of cloudy milky fluid was drained and therapeutic thoracentesis where 1.1 L of milky fluid was drained. Pleural fluid for triglycerides was 280. His peritoneal fluid had triglycerides of 671 confirming chylous ascites. CHF can lead to chylous ascites due to the increased lymph production in the abdomen, which flows to the thoracic duct. Due to the stiffness at the lymphatic junction, there is high pressure for less flow. The diaphragm plays a role allowing the chylous ascites to be absorb into the thorax.

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.

scholarly journals Increased Perioperative B-type Natriuretic Peptide Associates with Heart Failure Hospitalization or Heart Failure Death after Coronary Artery Bypass Graft Surgery

2013 ◽  
Vol 119 (2) ◽  
pp. 284-294 ◽  
Author(s):  
Amanda A. Fox ◽  
Luigino Nascimben ◽  
Simon C. Body ◽  
Charles D. Collard ◽  
Aya A. Mitani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Natriuretic Peptide ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hazard Ratio ◽  
Artery Bypass Graft ◽  
Clinical Model

Abstract Background: Heart failure (HF) is a leading cause of hospitalization and mortality. Plasma B-type natriuretic peptide (BNP) is an established diagnostic and prognostic ambulatory HF biomarker. We hypothesized that increased perioperative BNP independently associates with HF hospitalization or HF death up to 5 yr after coronary artery bypass graft surgery. Methods: The authors conducted a two-institution, prospective, observational study of 1,025 subjects (mean age = 64 ± 10 yr SD) undergoing isolated primary coronary artery bypass graft surgery with cardiopulmonary bypass. Plasma BNP was measured preoperatively and on postoperative days 1–5. The study outcome was hospitalization or death from HF, with HF events confirmed by reviewing hospital and death records. Cox proportional hazards analyses were performed with multivariable adjustments for clinical risk factors. Preoperative and peak postoperative BNP were added to the multivariable clinical model in order to assess additional predictive benefit. Results: One hundred five subjects experienced an HF event (median time to first event = 1.1 yr). Median follow-up for subjects who did not have an HF event = 4.2 yr. When individually added to the multivariable clinical model, higher preoperative and peak postoperative BNP concentrations each, independently associated with the HF outcome (log10 preoperative BNP hazard ratio = 1.93; 95% CI, 1.30–2.88; P = 0.001; log10 peak postoperative BNP hazard ratio = 3.38; 95% CI, 1.45–7.65; P = 0.003). Conclusions: Increased perioperative BNP concentrations independently associate with HF hospitalization or HF death during the 5 yr after primary coronary artery bypass graft surgery. Clinical trials may be warranted to assess whether medical management focused on reducing preoperative and longitudinal postoperative BNP concentrations associates with decreased HF after coronary artery bypass graft surgery.

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 Surgical treatment of coronary artery aneurysm with calcification and stenosis：a Case Report and Review of the Literature

2020 ◽  
Author(s):  
He Sun ◽  
Mingkui Zhang ◽  
Qingyu Wu ◽  
Hui Xue ◽  
Yongqiang Jin
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Artery ◽  
Coronary Artery Aneurysm ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Aneurysm ◽  
Causative Factor ◽  
Artery Bypass Graft ◽  
Review Of The Literature

Coronary artery aneurysm (CAA) has been increasingly reported in recent years. The symptoms are related to myocardial ischemia, such as angina pectoris, myocardial infarction, sudden death and congestive heart failure. This report describes a case of a giant CAA with calcification and stenosis involving two coronary arteries, and the patient underwent a complete arterialized coronary artery bypass graft successfully. In this report, all cases related to CAA with calcification and stenosis are summarized. According to the data, the following conclusions can be drawn: CAA seem to be more common in men; Kawasaki disease is likely to be a causative factor in some patients with asymptomatic CAA involving calcification and stenosis; CABG is a feasible treatment option for CAA with calcification and stenosis.

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