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Complication after arterial bypass grafting
Insights
A patient developed chest pain and respiratory distress after coronary artery bypass grafting (CABG). Echocardiogram revealed pericardial effusion and left ventricular thickening, suggesting post-operative cardiac complications.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- A 57-year-old male presented with symptoms of non-Q-wave myocardial infarction.
- He underwent four-vessel coronary artery bypass grafting (CABG) for significant coronary artery disease.
Observation:
- The patient experienced sudden pleuritic chest pain and respiratory distress 17 days post-CABG.
- An echocardiogram revealed a small pericardial effusion and moderate to severe left ventricular concentric thickening.
Findings:
- Left ventricular ejection fraction was 0.60, slightly below normal.
- Symptoms of chest pain persisted, appearing two days after the echocardiogram findings.
Implications:
- This case highlights potential cardiac complications following CABG, including pericardial effusion and ventricular remodeling.
- Early detection and monitoring are crucial for managing post-operative cardiac events.
Abstract:
A 57-year-old man experienced sudden onset of pleuritic chest pain and respiratory distress 10 days after undergoing four-vessel coronary artery bypass grafting (CABG). The surgery was performed after cardiac catheterization had shown right coronary artery dominance and the presence of lesions occluding 40% of the mid right coronary artery, 20% of the left main coronary artery, and 99% of the lower left anterior descending artery and its first diagonal branch. The patient had initially presented with acute dyspnea following an episode of crushing, nonradiating pain in the left chest and was diagnosed as having a non-Q-wave myocardial infarction after cardiac enzyme testing. His hospital course before and immediately after CABG was uneventful. The first sign of difficulty was detected one week after surgery, on day 17. An echocardiogram showed a small pericardial effusion, moderate to severe concentric thickening of the left ventricle, a left ventricular ejection fraction of 0.60 (normal, 0.67 +/- 0.08), normal valves, and normal segmental wall motion. The pleural chest pains began two days later, on day 19.