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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Retrograde Extrusion of Coronary Thrombus During Urgent Aortocoronary Bypass Surgery: A Case Report
Glenio B Mizubuti1, Yuri Koumpan, G Andrew Hamilton
1From the Departments of *Anesthesiology & Perioperative Medicine and †Surgery, Division of Cardiac Surgery, Queen's University & Kingston General Hospital, Kingston, Ontario, Canada.
Insights
A rare thrombus near the coronary artery ostium was found during bypass surgery. Transesophageal echocardiography helped identify and remove this unusual source of emboli, preventing serious complications.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Thrombosis Research
Background:
- Acute myocardial infarction often necessitates urgent coronary artery bypass grafting (CABG).
- Multivessel disease is a common finding in patients undergoing CABG.
- Complications during CABG can arise from unexpected sources.
Abstract:
A 73-year-old man underwent urgent coronary artery bypass grafting after an acute myocardial infarction. An angiogram had revealed multivessel disease with a circumflex artery lesion suspected as the primary culprit. On separation from cardiopulmonary bypass, transesophageal echocardiography revealed a new mobile mass in the aortic root. Cardiopulmonary bypass was reinstituted and a large thrombus emanating from the left coronary ostium was surgically removed. We hypothesize that the thrombus had originated from coronary retrograde extrusion during venous grafting. This case illustrates an unusual source of emboli during coronary artery bypass grafting and emphasizes the importance of perioperative transesophageal echocardiography for the prevention of potentially catastrophic outcomes.
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