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[Coronary artery bypass grafting for a patient with angina pectoris and ulcerative colitis]
1First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan.
Insights
Coronary artery bypass grafting is rarely performed in patients with ulcerative colitis. This case study details a successful surgery in a patient with severe coronary artery disease and ulcerative colitis, highlighting effective perioperative management.
Area of Science:
- Cardiology
- Gastroenterology
- Surgical Innovation
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease with potential systemic implications.
- Concurrent management of CABG and UC presents unique clinical challenges due to inflammatory and surgical risks.
Observation:
- A 63-year-old male with a history of myocardial infarction and ulcerative colitis presented with severe coronary artery disease.
- Cardiac catheterization revealed significant multi-vessel stenosis and reduced left ventricular ejection fraction (LVEF).
- The patient had active ulcerative colitis requiring management during the perioperative period.
Findings:
- Coronary artery bypass grafting was successfully performed with intra-aortic balloon pump (IABP) support and cardiopulmonary bypass.
- Perioperative management included aprotinin infusion and suppression of ulcerative colitis inflammation with prednisolone.
- Ulcerative colitis was controlled with 40 mg of prednisolone during the perioperative phase.
Implications:
- This case demonstrates the feasibility of CABG in patients with co-existing ulcerative colitis.
- Effective suppression of ulcerative colitis inflammation is crucial for successful surgical outcomes.
- Careful perioperative management strategies can mitigate risks associated with combined cardiovascular and gastrointestinal conditions.
Abstract:
The implementation of coronary artery bypass grafting for angina pectoris with ulcerative colitis has been rarely reported. A 63-year-old man has a past history of acute myocardial infarction in 1984 and ulcerative colitis since 1988. Coronary angiography and cardiac catheterization showed total obstruction of segment 2, 95% stenosis of segment 6, 75% stenosis of segment 7 and total obstruction of segment 12 with LVEF 23%. Coronary artery bypass grafting was performed under IABP support and cardiopulmonary bypass with aprotinin infusion after an inflammatory reaction of ulcerative colitis was adequately suppressed. Ulcerative colitis was controlled by administering 40 mg of predonisolone during perioperative period.