The combination of breast necrosis and chylothorax following the OPCAB

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Complications

Background:

• The internal mammary artery is a preferred graft for left anterior descending coronary artery revascularization due to its long-term patency.
• Its branches supply the chest wall and breast, and its proximity to thoracic duct branches poses a risk during harvesting.

Observation:

• A rare case of chylothorax and subsequent breast necrosis following coronary artery bypass grafting is presented.
• Chylothorax developed on postoperative day two and resolved by day twelve.
• Breast necrosis manifested three weeks post-surgery, characterized by pain, tenderness, and skin discoloration.

Findings:

• Harvesting the internal mammary artery can lead to thoracic duct injury, resulting in chylothorax.
• Compromised blood supply to the breast tissue, potentially due to altered arterial supply, can cause necrosis.
• This case highlights a rare but serious complication of internal mammary artery harvesting.

Implications:

• Surgeons must be aware of the potential for chylothorax and breast necrosis when using internal mammary artery grafts.
• Careful surgical technique and monitoring are crucial to minimize these risks.
• Further research may explore methods to mitigate these complications during coronary artery bypass grafting.