Document Detail

Wide sternal retraction may impede internal mammary artery graft flow and reduce myocardial function during off-pump coronary artery bypass grafting: presentation of two cases.
MedLine Citation:
PMID:  22499803     Owner:  NLM     Status:  MEDLINE    
The internal mammary artery (IMA) is routinely used for grafting of the left anterior descending coronary artery (LAD), providing good flow to the anterior left ventricle (LV) wall. Impeded IMA-to-LAD flow may result in myocardial ischaemia and haemodynamic deterioration. From a study population, we describe two incidents where myocardial ischaemia was observed during off-pump coronary artery bypass surgery (CABG), with a confirmed reduction in the IMA-to-LAD flow in one patient. In patient no. 1, normal IMA flow was assessed by transit-time flow measurement after a complete IMA-to-LAD anastomosis. The anterior LV wall thickening was monitored continuously by epicardial ultrasonic transducers. Normal wall thickening was confirmed after IMA grafting. During a wide sternal opening for circumflex grafting the anterior wall motion displayed an ischaemic pattern, with reduced systolic and increased post-systolic wall thickening. IMA flow was reduced simultaneously. When easing the sternal opening, IMA flow normalized, as did the motion pattern in the anterior LV wall. In patient no. 2, similar changes in wall thickening occurred during a wide sternal opening after IMA-to-LAD grafting. When easing the retractor, the wall thickening normalized. It is important for the surgeon to be aware of this possible cause of myocardial ischaemia, with a risk of subsequent haemodynamic deterioration. This may not only be of great importance during off-pump CABG, but can also be significant for successful weaning from the cardiopulmonary bypass machine.
Andreas Espinoza; Jacob Bergsland; Runar Lundblad; Erik Fosse
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2012-04-11
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-22     Completed Date:  2012-10-29     Revised Date:  2013-07-02    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  42-4     Citation Subset:  IM    
The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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MeSH Terms
Coronary Artery Bypass, Off-Pump*
Internal Mammary-Coronary Artery Anastomosis*
Mammary Arteries / physiopathology,  surgery*
Monitoring, Intraoperative / methods
Myocardial Contraction
Myocardial Ischemia / diagnosis,  etiology*,  physiopathology
Predictive Value of Tests
Regional Blood Flow
Sternotomy / adverse effects*
Ventricular Function, Left
Comment In:
Interact Cardiovasc Thorac Surg. 2012 Jul;15(1):44   [PMID:  22723542 ]

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