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Coronary artery bypass grafting for left main trunk coronary artery lesion associated with essential thrombocythemia
T Momiyama1, T Hiranaka, F Nomura
1Department of Cardiovascular Surgery, Kinan General Hospital, Wakayama, Japan.
Insights
A 58-year-old man with left main trunk disease and essential thrombocythemia underwent coronary artery bypass grafting. Postoperative complications, including myocardial and cerebral infarction, arose despite patent grafts, highlighting therapeutic challenges.
Area of Science:
- Cardiology
- Hematology
- Vascular Surgery
Background:
- A 58-year-old male presented with effort angina attributed to left main trunk (LMT) stenosis.
- Concurrent diagnosis of essential thrombocythemia with markedly elevated platelet count.
Observation:
- Coronary artery bypass grafting (CABG) was performed for LMT disease before essential thrombocythemia treatment.
- Patient experienced no intraoperative or early postoperative complications.
- Postoperative administration of melphalan successfully reduced platelet count.
Findings:
- Postoperative coronary angiography confirmed both CABG grafts were patent.
- Sudden onset myocardial infarction and cerebral infarction occurred immediately after coronary angiography.
Implications:
- This case highlights the complex therapeutic challenges in managing patients with concurrent coronary artery disease and hematological disorders.
- The interplay between thrombocythemia, anticoagulation, and cardiovascular interventions requires careful consideration to prevent thromboembolic events.
Abstract:
Effort angina due to left main trunk (LMT) lesion was diagnosed in a 58-year-old man. Platelet count was markedly increased and essential thrombocythemia was also diagnosed. Because of LMT disease, coronary artery bypass grafting (CABG) was performed prior to medication for essential thrombocythemia. There were no complications during the operation or in the early postoperative period. Melphalan was administered postoperatively resulting in the decrease of platelet count. Postoperative coronary angiography demonstrated that both grafts were patent; however, immediately after coronary angiography, the patient suffered from a sudden onset of myocardial infarction and cerebral infarction. The therapeutic problems associated with hematological disorder in such patients are discussed in this report.