1.
Acute Compartment Syndrome of the Lower Leg after Coronary Artery Bypass Grafting: A Silent but Dangerous Complication.
Te Kolste, HJ, Balm, R, de Mol, B
The Thoracic and cardiovascular surgeon. 2015;(4):300-6
Abstract
BACKGROUND Acute compartment syndrome (ACoS) is a serious, limb-threatening condition, but ACoS after coronary artery bypass grafting (CABG) is rare. ACoS is diagnosed with the help of typical symptoms, but due to the use of analgesics in a postoperative setting, these symptoms may vary. Identifying risk factors for ACoS after CABG could reduce the risk of developing this complication. METHODS We describe the clinical presentation, diagnosis, and management of five cases of ACoS arising from CABG procedures at our institution during the last 5 years. We also review all cases found in literature about this complication. DISCUSSION Both systemic and local factors may contribute to ACoS of the lower leg. These factors include increased microvascular permeability caused by cardiopulmonary bypass (CPB), the use of cardiac-assist devices causing arterial occlusion and reperfusion injury, diminished arterial blood flow in patients with peripheral vascular disease due to lithotomy position and the use of elastic bandages and local trauma and hematoma formation due to the harvesting of the greater saphenous vein (GSV). CONCLUSION To prevent this serious complication, we advise to pay extra attention to the patients with a greater risk. Hemostasis after venectomy in CABG surgery is mandatory, especially in the endoscopic harvesting of the GSV. Elastic bandages should be applied after weaning from CPB. Elevated creatine phosphokinase values may indicate ACoS. When suspicion arises, intracompartmental pressure measurement is the preferred tool for early recognition and diagnosis. To prevent irreversible, extensive tissue damage and permanent disability fasciotomy must be performed immediately after the diagnosis is made.
2.
Acute kidney injury associated with rhabdomyolysis after coronary artery bypass graft: a case report and review of the literatures.
Sudarsanan, S, Omar, AS, Pattath, RA, Al Mulla, A
BMC research notes. 2014;:152
Abstract
BACKGROUND Post-operative rhabdomyolysis is a well-known complication, especially after bariatric and orthopaedic surgeries. There are few published reports of rhabdomyolysis following cardiac surgery. Acute kidney injury had been distinguished as a serious complication of cardiac surgery. We report a case of 55-years-old male patient who developed rhabdomyolysis precipitated acute kidney injury after coronary artery bypass graft. CASE PRESENTATION The patient underwent urgent coronary artery bypass graft surgery, with a long duration of surgery due to technical difficulty during grafting. He developed rhabdomyolysis induced acute kidney injury necessitating hemodialysis. The patient in turn developed heart failure, which along with acute kidney injury lead to prolonged ventilation. There was supervening sepsis with prolonged intensive care unity stay and eventually prolonged hospitalization. The peak creatine kinase level was 39,000 IU/mL and peak myoglobin was 40,000 ng/ml. Reviewing the patient, surgery was prolonged due to technical difficulties encountered during grafting, leading to rhabdomyolysis induced acute kidney injury. The pre-operative use of statins by the patient could also have contributed to the development of rhabdomyolysis. He developed post-operative right heart failure and sepsis. The patient's renal function gradually improved over 4 week's duration. Favorable outcome could be achieved but after prolonged course of renal replacement therapy in the form of hemodialysis. CONCLUSION Prolonged duration of surgery is a well-recognized risk factor in the development of rhabdomyolysis. Early recognition of rhabdomyolysis induced acute kidney injury is important in reducing the post-operative morbidity and mortality in patients. A protocol based approach could be applied for early recognition and management.
3.
Scintigraphic demonstration of myocardial perfusion and ischaemia associated with coronary artery bypass grafting.
Larstorp, AC, Lund Søraas, C, Tønnessen, T, Müller, C, Kjeldsen, SE, Mangschau, A
Scandinavian cardiovascular journal : SCJ. 2006;(6):354-62
Abstract
OBJECTIVES To assess if myocardial perfusion scintigraphy (MPS) at rest can be of value in elucidating myocardial perfusion, ischaemia and perioperative myocardial infarction (PMI) associated with coronary artery bypass graft (CABG) surgery. DESIGN This was a prospective randomized study of patients undergoing elective CABG. Forty-eight patients in the control group underwent serial ECG recordings and measurements of CK-MB and cTnT. Fifty-four patients in the study group were additionally examined with MPS preoperatively and 2-4 days and 6 weeks postoperatively. RESULTS The study showed a highly significant (p < 0.001) improvement in myocardial radionuclide uptake from preoperatively to 2-4 days postoperatively. Judged from ECG and enzymatic changes, two control patients and one study patient only had PMI and no additional cases of PMI were demonstrated by MPS. CONCLUSION MPS at rest showed that CABG significantly improved myocardial perfusion, by demonstrating an increase in radionuclide uptake. In diagnosing PMI, we found that MPS provided no additional information beyond cardiac biochemical markers and ECG changes.