Download Successful surgical revascularization strategy in a patient with

Successful surgical revascularization strategy in a patient with serious left main
coronary artery disease and low ejection fraction in third hour of myocardial infarction
with on going chest pain
Ufuk Yetkin**, Kazım Ergüneş*, Köksal Dönmez*, Ali Gürbüz*.
Department of Cardiovascular Surgery, Katip Celebi University Izmir Ataturk Training
And Research Hospital, Izmir, Turkey
Objective:Surgical intervention to coronary arteries may be performed with great risk in first
six hours of myocardial infarction. Mortality and morbidity of intervention increases with
serious left main coronary artery lesion.
Methods:Our case was 64 year-old male patient. Three hours before his admission to our
center, he admitted to emergency service for suffering serious chest pain. ECG was consistent
with acute general anterior MI. Troponin I level was over 4 IU and pain was increasing.
Emergent coronary angiography was planned. Transthoracic echocardiography revealedleft
ventricle’s ejection fraction as 40%. In addition, left ventricle dimension were hypertrophic
(LVd/s diameter: 55/42 mm). Coronary angiography revealed an 80% stenosis of left main
coronary artery and multiple stenotic lesions of coronary arteries. In his medical history, he
has been extensively using tobacco products for 50 years.
Results:Due to ongoing angina and third hour of MI, high-risk emergency coronary
revascularization was planned in the council. Femoral sheath placed for angiography was left
in place for possibility of intraaortic balloon pump requirement and arterial monitorization.
Anesthetic induction was performed with IV coronary dilator medications and morphine.
After median sternotomy and pericardiotomy, routineaorta cannulation of and two-stage
venous cannulation, antegrade cardioplegia was initiated. Retrograde cardioplegiawas
continued through operation. Four vessels (LAD, intermediate, CxOM3, right CRUX) were
revascularized by using native saphenous vein. Patient successfully weaned from
cardiopulmonary bypass. Patient recovered uneventfully. Intense respiratory physiotherapy
was performed afterwards.
Conclusion:For patients with new onset MI, serious left main coronary artery disease, and
increasing angina, dynamic and multidisciplinary approach is essential after obtaining
emergent coronary angiography. Additional morbid factors will increase the perioperative
risk. Only by this method, optimal survival ratesand safetyof patients may be achieved.