To evaluate the clinical significance of the plasma and urinary levels of heart fatty acid-binding protein (H-FABP) in patients undergoing cardiac surgery, a prospective study was conducted. Ten patients undergoing coronary artery bypass grafting were enrolled. Blood samples for determination of plasma H-FABP (pH-FABP), the MB isoenzyme of creatine kinase (CK-MB) and troponin-T (TnT), and urine samples for determination of urinary H-FABP (uH-FABP) were collected serially. None of the patients had perioperative myocardial infarction. The time to reach the peak level after aortic declamping was significantly (p<0.05) shorter for pH-FABP (1.4+/-0.5 h) than for CK-MB (2.5+/-0.5 h), TnT (6.6+/-1.3 h) or uH-FABP (3.0+/-0.6 h). Peak levels of pH-FABP correlated with those of CK-MB (r = 0.51, p = 0.04), TnT (r = 0.60, p = 0.03) and uH-FABP (r = 0.61, p = 0.03), and peak levels of uH-FABP correlated with CK-MB (r = 0.57, p = 0.04). Postoperative uH-FABP levels correlated inversely with the left ventricular stroke work index (r = -0.63, p = 0.04). This study demonstrated that H-FABP appears rapidly in plasma after reperfusion and reaches its peak earlier than other available biochemical markers; it appears also in urine and the levels correlated with cardiac function. Plasma and urinary H-FABP may be an early and sensitive biochemical marker for the diagnosis of myocardial injury in patients undergoing cardiac surgery.
A 73-year-old man with myasthenia gravis required quadruple coronary artery bypass grafting due to triple-vessel disease. Anesthetic management was performed with general anesthesia using a reduced dose of muscle relaxant with the aid of a neuromuscular transmission monitor. He was extubated 14 hrs after surgery without difficulty under this monitor. His postoperative course was uneventful. A patient with myasthenia gravis who required coronary artery bypass surgery was successfully performed by the deliberate preoperative evaluation of patient's myasthenic and cardiac status, and by the careful perioperative management.
Based on the superior long-term results, internal thoracic artery is widely used for coronary artery bypass grafting. However, the vessel can play an important role as a collateral source to the chronically ischemic lower limbs. We reported two cases who underwent simultaneous revascularization to the myocardium and lower limbs because this particular condition was anticipated. Selective angiography of internal thoracic artery was useful to determine its role before harvesting in our cases. Careful preoperative examinations and choice of surgical approach are required for such patients to avoid serious vascular complications.
We report on a 71-year-old woman who underwent successful graft replacement for a ruptured thoracoabdominal aortic aneurysm into the right chest. Computed tomographic scans revealed aneurysmal dilatation of the descending thoracic and thoracoabdominal aorta, and a large right posteroinferior hemothorax with a small left extrapleural hematoma. Digital subtraction angiography showed the aortic aneurysm arising 4 cm distal to the origin of the left subclavian artery and extending to just proximal to the origin of the celiac axis. Emergency graft replacement of the thoracoabdominal aortic aneurysm was performed with a partial cardiopulmonary bypass through the femoral artery and vein. Although the patient required respiratory support with a mechanical ventilator for 48 days, she is presently doing well without limit to activities of daily living 12 months after surgery. We suggest that a combination of computed tomographic scans and aortography is useful in making a correct diagnosis of the extent of the aortic aneurysm and in helping to decide surgical procedures and supportive methods.
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