Can Myocardial Stunning Contribute to Myocardial Infarction During Coronary Artery Bypass Surgery?

Jain, Madhulika

doi:10.1111/j.1540-8191.1993.tb01315.x

Cited by 2 publications

(3 citation statements)

References 32 publications

(15 reference statements)

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“…Coronary angiography is the criterion standard for graft assessment yet seldom used in the postoperative period, despite the knowledge that 5% to 9% of the grafts block in the immediate postoperative period. 4,16 Once again, although patients with graft occlusion have significantly higher incidence of new Q waves and higher peak troponin values, the overlap with patients without graft occlusion is substantial, and the patency status in the individual cannot be reliably predicted from these noninvasive tests. Because of the surgical trauma, the usual indicators of myocardial infarction (pain, ECG changes, and elevated biochemical markers of infarction) have uncertain diagnostic value.…”

Section: Discussionmentioning

confidence: 99%

Angiography for Management of Perioperative Myocardial Ischemia: Does it Have Any Role?

Narayan

Bandyopadhyay

Khan

et al. 2014

Innovations�(Phila)

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Objective Perioperative myocardial ischemia (PMI) is a relatively rare but potentially fatal complication after coronary artery bypass grafting and is due to graft-related problems in a significant proportion of cases. The usual indicators of MI in the postoperative setting are unreliable and therefore have uncertain diagnostic value. Angiography, the criterion standard for preoperative angina, remains underused for evaluation of PMI. The aim of this study was to evaluate the role of angiography in the management of PMI. Methods Between January 2011 and September 2012, a total of 2312 isolated primary consecutive coronary artery bypass graft surgeries were performed, of which 2057 (89%) were carried out on the beating heart. Twenty-six (1.12%) of these patients needed perioperative angiography. The patients needing angiography were selected on the basis of a number of clinical, biochemical, and other diagnostic parameters Results Twenty-six patients with PMI required angiography, of which 18 (69 %) were found to have graft-related issues. The mean (SD) time between operation and angiography was 24.58 (6.71) hours. Of the 18 patients, 17 (94.44%) required surgical intervention and 1 patient was treated with angioplasty. There were 2 deaths (11.1%) in the group undergoing intervention. Angiographic findings included occluded vein graft (n = 7), narrowing of the left internal mammary artery (n = 3), and kinking or stretching of grafts (n = 8). Conclusions Angiography is useful in diagnosing graft-related problems in the perioperative period. In presence of signs of graft compromise, we suggest that having a low threshold for angiographic graft evaluation may be beneficial in a carefully selected subset of patients after coronary artery bypass.

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Section: Discussionmentioning

confidence: 99%

Angiography for Management of Perioperative Myocardial Ischemia: Does it Have Any Role?

Narayan

Bandyopadhyay

Khan

et al. 2014

Innovations�(Phila)

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“…Thus, myocardial ischemia is a major problem after CPB. 96,97 Greater understanding of this problem will allow development of methods for improving the outcome after cardiac surgery.…”

Section: Othereffectsmentioning

confidence: 99%

“…Vasospasm and thrombosis also may be observed in the perioperative period. [1][2][3][4] There are many case reports of angiographically proven coronary vasospasm after CPB and early in the postoperative period.5-12 These episodes often are associated with myocardial infarction (MI) and ST elevation on the ECG. [5][6][7][8][9][10][11][12] Vasospasm during this period may occur even in patients not demonstrated to have vaso-spasm during any other period.…”

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confidence: 99%

Myocardial Ischemia After Cardiopulmonary Bypass

Jain

1995

J Cardiac Surgery

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Intraoperatively, myocardial ischemia is more common after cardiopulmonary bypass (CPB) than before CPB. Ischemia associated with coronary vasospasm and thrombosis may be much more common toward the end of surgery and early in the postoperative period than previously appreciated. This may be because the coagulation system is altered during CPB, and the coronary endothelium is damaged significantly as a result of cardioplegic arrest followed by reperfusion. In this milieu, vasospasm and thrombosis may be caused by the administration of protamine. Some of the ischemia observed in this period actually is not reversible and is associated with myocardial injury and infarction. It may be ameliorated by the administration of calcium channel blockers, aspirin, and anticoagulants. Electrocardiography may be the most suitable modality for the detection of ischemia after CPB and postoperatively. During this period, many episodes of ST deviation are of a nonischemic etiology, and the ECG needs careful interpretation. Transesophageal echocardiography is suitable for use intraoperatively and early on in the intensive care unit.

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Can Myocardial Stunning Contribute to Myocardial Infarction During Coronary Artery Bypass Surgery?

Cited by 2 publications

References 32 publications

Angiography for Management of Perioperative Myocardial Ischemia: Does it Have Any Role?

Angiography for Management of Perioperative Myocardial Ischemia: Does it Have Any Role?

Myocardial Ischemia After Cardiopulmonary Bypass

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