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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.
The Journal of Tehran Heart Center
|January 11, 2013
Summary
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.
