Spinal cord infarction following intraaortic balloon support

Area of Science:

• Cardiovascular Surgery
• Neuropathology
• Vascular Medicine

Background:

• Intraoperative complications can arise from cardiac surgeries, including those involving aortic manipulation.
• Spinal cord ischemia is a rare but devastating complication following aortic procedures.
• The use of intraaortic balloon pumps (IABP) is common in complex cardiac surgeries.

Observation:

• A 72-year-old male developed acute paraplegia post-coronary artery bypass grafting and atrial septal defect repair.
• The patient had an intraaortic balloon pump inserted during the surgery.
• Autopsy revealed lumbar and sacral spinal cord infarction.

Findings:

• Autopsy confirmed spinal cord infarcts and infarcts in other organs.
• The cause of infarction was critical occlusion of small arterioles by cholesterol emboli.
• Cholesterol emboli originated from fragmented atheromatous plaques in the aorta, likely due to IABP use.

Implications:

• Intraaortic balloon pump use in patients with significant aortic atheromatous disease carries a risk of cholesterol microembolism.
• This mechanism can lead to spinal cord infarction and other organ damage.
• Awareness of this complication is crucial for risk assessment and management in cardiac surgery patients.