scholarly journals Incidentally Detected Sternal Foramen during an Urgent Surgical Revascularization: A Case Report

2020 ◽  
Author(s):  
Elif Coşkun Sungur ◽  
Ufuk Tütün ◽  
Anıl Tekin
Keyword(s):  
Coronary Artery ◽  
Heart Surgery ◽  
Anatomical Variation ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Sudden Onset ◽  
Coronary Syndrome ◽  
First Case ◽  
Great Vessels ◽  
Sternal Foramen

The sternal foramen is an anatomical variation at the lower third of the sternum which carries the risk of life-threatening complications such as pneumothorax. It is usually asymptomatic and can be misinterpreted as an acquired lesion. The sternum is close to the mediastinal structures; the sternal foramen, thus, leaves the lung, heart, and great vessels unprotected during invasive procedures. A 61-year-old male patient was admitted to our emergency department with sudden-onset chest pain. Acute coronary syndrome was diagnosed by the cardiology department. Coronary angiography confirmed the diagnosis of coronary artery disease, and the patient underwent urgent coronary artery bypass grafting. During the exploration, sternotomy was performed with a proper incision. Two sternal images were obtained via the median incision, and a sternal foramen was detected intraoperatively. To the best of our knowledge, this is the first case of sternotomy to undergo open-heart surgery for coronary heart disease and to be diagnosed with the sternal foramen intraoperatively. It is of vital importance that surgeons and interventionists recognize the sternal foramen, which leaves the mediastinal structures unprotected, and take early precautions.

Cefazolin-Induced Thrombocytopenia in a Patient with Polycythemia Vera Following Coronary Artery Bypass

2021 ◽  
pp. 108925322110652
Author(s):  
Racha Boulos ◽  
Katja Turner ◽  
Samiya Saklayen ◽  
William Perez ◽  
Manoj H. Iyer
Keyword(s):  
Coronary Artery ◽  
Polycythemia Vera ◽  
Coronary Artery Bypass ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Surgical Site Infections ◽  
First Case ◽  
Minor Surgery ◽  
Severe Coagulopathy

Cefazolin is an antibiotic that is commonly administered perioperatively to reduce the risk of surgical site infections. Cephalosporins have a well-established safety profile, but have been associated with thrombocytopenia and neutropenia due to their myelosuppressive effects. While this effect may be benign in healthy patients undergoing minor surgery, it can be detrimental in patients with underlying hematologic disorders presenting for open-heart surgery. Herein, we discuss the first case in the literature of cefazolin-induced thrombocytopenia and severe coagulopathy in a patient with polycythemia vera (PCV) during a coronary artery bypass-grafting surgery.

Off-Pump Coronary Artery Bypass Surgery May Produce a Hypercoagulable Patient

2005 ◽  
Vol 6 (2) ◽  
pp. 94 ◽  
Author(s):  
Robert L. Quigley ◽  
David W. Fried ◽  
John Pym ◽  
Richard Y. Highbloom
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Anticoagulation Therapy ◽  
Maximum Amplitude ◽  
Platelet Activity ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

<P>Background: The incidence of thromboembolic events following traditional open heart surgery has not been clinically significant. However, with beating heart surgery, for which cardiopulmonary bypass (CPB) is not required, the incidence of spontaneous intravascular thrombosis may be similar to that encountered after general surgeries. Compounding this risk is that many cases of off-pump coronary artery bypass (OPCAB) surgery are reserved for the elderly patient with multiple comorbidities. The few studies to date that have assessed the coagulation profile in OPCAB patients have been limited to the first 24 hours after surgery. </P><P>Methods: We prospectively studied 17 OPCAB and 6 on-pump patients over 4 days (hospital course) with daily thromboelastography. A coagulation index (CI) (reflecting R and K times, a angle, and maximum amplitude [MA]) was calculated for the patients, who served as their own controls. </P><P>Results: The OPCAB patients demonstrated 3 days postoperatively a 17% increase in coagulation compared with the baseline. Specifically, the CI consistently revealed an elevation in the a angle and the MA, both of which reflect increased fibrinogen and platelet activity. On the other hand, 3 days following surgery the CI of the CPB group was tightly clustered around their respective baseline CI values, which had recovered from a significant decrease immediately after surgery. </P><P>Conclusion: A state of hypercoagulability, as measured by thromboelastography, exists in the OPCAB patient beyond the first postoperative day, and this finding suggests that prophylactic postoperative anticoagulation therapy targeting fibrinogen and platelet activity may be indicated for these patients.</P>

scholarly journals Off-pump myocardial revascularization using the octopus tissue stabilizer system

2003 ◽  
Vol 56 (1-2) ◽  
pp. 80-84 ◽  
Author(s):  
Predrag Milojevic ◽  
Vojislava Neskovic ◽  
Dragos Stojanovic ◽  
Miroslav Jakovljevic ◽  
Sava Nenic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Open Heart Surgery ◽  
Myocardial Revascularization ◽  
Arterial Grafts ◽  
Off Pump ◽  
Coronary Artery Revascularization ◽  
Pump Coronary Artery Bypass

Off-pump coronary artery bypass surgery (OPCAB) has changed the approach to contemporary coronary surgery. Development of new surgical devices and techniques has reduced morbidity and mortality during off-pump surgery. From March 2000 - April 2002, a total of 136 patients underwent open heart surgery using off-pump technique and fast-track anesthesia at Dedinje Cardiovascular Institute. Octopus Medtronic coronary stabilizer was used for stabilization of targeted vessel. Arterial grafts were used 169 times and saphenous vein 69 times. Average number of anastomoses was 1,830,73 per patient. One patient (0.74%) died. Three patients (2.21%) underwent surgery revision due to postoperative bleeding and one (0.74%) because of graft dysfunction Perioperative myocardial infarction was registered 2 times (1.47%) pneumothorax 3 times (2.21%), postoperative arrhythmias 11 times (8.09%) transitory ischemic attack once (0.74%) and deep wound infection once (0.74%). Twelve patients (8.82%) required prolonged inotropic support Angiographies early revealed patent grafts in 8 patients (5.88%). OPCAB is a safe and effective alternative approach to coronary artery revascularization Use of coronary stabilizer has improved the safety and quality of OPCAB surgery.

Sternal Wound Infections

1993 ◽  
Vol 4 (3) ◽  
pp. 475-483
Author(s):  
Patricia L. Vaska
Keyword(s):  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Signs And Symptoms ◽  
Diabetic Patients ◽  
Wound Infections ◽  
Great Vessels ◽  
Internal Mammary ◽  
The Common ◽  
Sternal Wound Infections

Sternal wound infections are a major cause of morbidity and mortality in patients undergoing cardiac surgery. They occur in 1% to 3% of patients who undergo open-heart surgery and carry a 20% to 40% mortality rate. Sternal infections can range from minor, superficial infections to open mediastinitis with invasion of the sternum, heart, and great vessels. Staphylococcus species arc responsible for the majority of sternal infections, but environmental sources can cause infections by other organisms. The common signs and symptoms of mediastinitis are fever, leukocytosis, sternal instability, drainage, and pain. Several risk factors exist for sternal wound infection, with bilateral internal mammary artery bypass grafting in diabetic patients being the most common. Treatment entails surgical debridement with cither closed irrigation, open-wound packing, or muscle or omental flap procedures, as well as antibiotic therapy. Some simple procedures help limit the development of sternal infections in certain patients

Late Cardiac Tamponade by Chylous Pericardial Effusion after Coronary Artery Bypass Surgery: Case Report

2011 ◽  
Vol 14 (3) ◽  
pp. 195 ◽  
Author(s):  
Anders Albåge ◽  
Gösta Eggertsen ◽  
Paolo Parini
Keyword(s):  
Coronary Artery ◽  
Pericardial Effusion ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Successful Outcome ◽  
Pericardial Fenestration

Chylopericardium is an uncommon but serious complication after open heart surgery that often necessitates surgical treatment. We describe a case of continuous and severely symptomatic chylous pericardial effusion after coronary artery bypass grafting in which the diagnosis was established by lipid electrophoresis. Initial conservative management failed, and ligation of the thoracic duct and pericardial fenestration were finally required for a successful outcome.

scholarly journals Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Abdorasoul Anvaripour ◽  
Forouzan Yazdanian ◽  
Mohammad-Zia Totonchi ◽  
Houshang Shahryari
Keyword(s):  
Coronary Artery ◽  
Mitral Valve ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Venous Catheter ◽  
Mitral Valve Stenosis ◽  
Artery Disease ◽  
Vessel Coronary Artery

A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG) surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause.

scholarly journals Effect of Melatonin on Incidence Rate of Delirium in Elderly Patients Undergoing Open-Heart Surgery without a Pump: A Clinical Trial

2019 ◽  
Author(s):  
Fatemeh Hosseini Kasnavieh ◽  
Hassan Rezaeipandari ◽  
Mehdi Hadadzadeh ◽  
Mahmood Vakili ◽  
Fatemeh Hosseini Biouki
Keyword(s):  
Clinical Trial ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Control Group ◽  
Open Heart

Introduction: Delirium has been considered as the most common cognitive disorder after major surgery. Melatonin therapy is effective in reducing the incidence of delirium after open heart surgery with pain relief mechanism and adjustment of the sleep cycle and the absence of specific side effects. This study was conducted to determine the effectiveness of melatonin on prevention of delirium after coronary artery bypass surgery.   Methods: The double blind randomized controlled clinical trial  recruited 140 patients, equally decided, who underwent  coronary artery bypass surgery in Afshar Hospital, Yazd city, 2016. All participants of the two groups were evaluated for the presence of delirium  on the day of surgery and three days after by the Confusion Assessment Method for ICU (CUM-ICU). Respectively, The intervention and control group received 3 mg melatonin and 3 mg placebo orally before and after the operation. Data were analyzed by Chi-square, T-test, paired t-test and Cochran tests.   Results: The incidence of delirium in the melatonin and the control group was 35.7% and 5.7% on the day of operation, 68.6% and 31.4% three days after the operation, respectively. The results showed that there was a significant difference in the frequency of cognitive test of CAM-ICU on day of surgery and three days after surgery between the two groups (p <0.001).   Conclusion: Despite the efficacy of melatonin therapy in reducing delirium, further studies on the effects of other effective drugs on the treatment of delirium, such as antipsychotics and receptor blockers, should be considered.  

Coronary Artery Bypass Surgery in a Patient with a Functional Single Lung

2005 ◽  
Vol 13 (4) ◽  
pp. 377-379 ◽  
Author(s):  
Levent Yazicioglu ◽  
Atilla Aral ◽  
Ozge Uymaz ◽  
Hakki Akalin
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Heart Surgery ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Postoperative Management ◽  
Open Heart ◽  
Mortality And Morbidity

Destructed lung and pneumonectomy are associated with anatomic and physiologic changes that may interfere with the conduct of subsequent open heart surgery. Here we report a case of an autopneumonectomized patient who required open heart surgery. The preoperative, intraoperative and postoperative management of this patient was unique. Open heart procedures on patients with a single lung can be performed with acceptable operative mortality and morbidity.

The New Era of Cardiac Surgery Hybrid Therapy for Cardiovascular Disease

2010 ◽  
Vol 5 (6) ◽  
pp. 388-393 ◽  
Author(s):  
Natalia V. Solenkova ◽  
Ramanan Umakanthan ◽  
Marzia Leacche ◽  
David X. Zhao ◽  
John G. Byrne
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Bypass Grafting ◽  
Hybrid Strategy ◽  
Artery Bypass Grafting

Surgical therapy for cardiovascular disease carries excellent long-term outcomes but it is relatively invasive. With the development of new devices and techniques, modern cardiovascular surgery is trending toward less invasive approaches, especially for patients at high risk for traditional open heart surgery. A hybrid strategy combines traditional surgical treatments performed in the operating room with treatments traditionally available only in the catheterization laboratory with the goal of offering patients the best available therapy for any set of cardiovascular diseases. Examples of hybrid procedures include hybrid coronary artery bypass grafting, hybrid valve surgery and percutaneous coronary intervention, hybrid endocardial and epicardial atrial fibrillation procedures, and hybrid coronary artery bypass grafting/carotid artery stenting. This multi-disciplinary approach requires strong collaboration between cardiac surgeons, vascular surgeons, and interventional cardiologists to obtain optimal patient outcomes.

scholarly journals Coronary Artery Bypass Graft Surgery in Tanzania: 5 Years of Experience at Jakaya Kikwete Cardiac Institute

2020 ◽  
Author(s):  
Mohamed Yakubu Janabi ◽  
Evarist Nyawawa ◽  
Bashir Nyangasa ◽  
William Ramadhani Ramadhan ◽  
Ramadhani Hassan Hamis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
World Health

Abstract Cardiac surgery is not widely available in most developing countries, and most patients have no choice but to live in morbid conditions and managed conservatively or the few who are referred abroad for surgical procedures costs the respective countries millions of hard earned foreign currency. The World Health Organization projects that over the next ten years the continent of Africa will experience the largest increase in death rates from cardiovascular disease. The Jakaya Kikwete Cardiac Institute (JKCI) is a government owned National Specialized and Teaching Hospital that serves patients from all the regions of the United Republic of Tanzania with a population of nearly 60,000,000 people and also serves beyond the borders (Rwanda, Burundi, DR Congo, South Sudan, Comoro, Malawi and Zambia) for advanced cardiovascular medical, intervention, vascular and open heart surgery, the Institute was established in 2015. Methods: Here we report all patients who underwent coronary artery bypass surgery grafting only performed at the Centre since its inauguration in 2015- till 2019. Data were collected for basic demography, diagnosis, investigations, clinical and surgical outcome parameters. Results: A total of 85 patients with heart diseases and underwent coronary artery bypass surgery grafting (CABG) are analysed in this study. There were 64 (75%) male and 21 (25%) female patients. Their age ranged from 41–85 years old with almost half 42 (49%) of the cohort being between the age between 61–70 years old. Most of the patients had two or more grafts and an internal mammary artery graft was used over 80% of the procedures. The overall 30-day mortality was 7.1%, incidence of stroke 0.2%, duration of mechanical ventilation was an average of 9.98 hours and intensive care unit (ICU) stay post CABG was an average of 6.48 days and final discharge from the centre ranged from 10–16 days.Conclusion: This study has demonstrated that coronary artery bypass surgery grafting in low/middle income country is safe and feasible. A sustainable program demands highest level of governmental support as seen in this case, and a dedicated multidisciplinary team with profound know how in cardiac pathologies. Furthermore, a need for good local data to know the prevalence of coronary disease is mandatory to determine the magnitude of coronary artery disease in each country.

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