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Off-pump coronary bypass grafting causing stunned myocardium
Feridoun Sabzi1, Naser Hemati, Abdoul Hamid Zokaei
1Imam Ali Heart Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Insights
Stunned myocardium, a rare complication of off-pump coronary artery bypass grafting (CABG), can cause temporary low cardiac output. This case highlights its transient nature and eventual full recovery of left ventricular function.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Stunned myocardium, characterized by impaired myocardial function post-reperfusion, is typically associated with on-pump coronary artery bypass grafting (CABG).
- Its occurrence in off-pump CABG is exceptionally rare, presenting a diagnostic and therapeutic challenge.
Observation:
- A 53-year-old male with severe left anterior descending artery and obtuse marginal stenosis developed low cardiac output six hours post-off-pump CABG.
- Initial assessment excluded cardiac tamponade and graft dysfunction; cardiac enzymes were normal.
Findings:
- The patient required intensive hemodynamic support, including inotropic agents and an intra-aortic balloon pump, for stabilization.
- Coronary angiography confirmed patent grafts. Echocardiography revealed transient left ventricular wall motion abnormalities (akinesia progressing to dyskinesia) that resolved by discharge.
Implications:
- This case underscores that stunned myocardium, though rare, can occur after off-pump CABG.
- Prompt hemodynamic management and monitoring are crucial for recovery, with potential for complete functional restoration.
Abstract:
The term "stunned myocardium" refers to abnormalities in the myocardial function following reperfusion and is common in on-pump coronary artery bypass grafting (CABG) and is exceedingly rare in off- pump CABG. A 53-year-old man presented with unstable angina due to the severe stenosis of the left anterior descending coronary artery (LAD) and the obtuse marginal. Laboratory findings and Chest X-ray revealed nothing abnormal. The intraoperative course was uneventful. The patient left the operating room without any inotropic support. Six hours later, however, he developed low cardiac output. At exploration, cardiac tamponade was excluded and flowmetry showed that the graft had adequate function. Cardiac enzymes were normal. High-dose adrenalin and Dobutamine were administrated and an intra-aortic balloon pump was used. After hemodynamic stabilization, the patient left the Intensive Care Unit without an intra-aortic balloon pump and inotropic support. On the fifth postoperative day, coronary angiography showed patent grafts and correct anastomotic sites. On the seventh postoperative day, the akinetic lateral wall of the left ventricle changed to dyskinesia. Finally after hospital discharge on the thirtieth postoperative day, an echocardiogram showed normal left ventricular function without regional wall motion abnormalities.
