Off-pump coronary bypass grafting causing stunned myocardium

Abstract

The term "stunned myocardium" refers to abnormalities in the myocardial function following reperfusion and is common in on-pump coronary artery bypass grafting (CABG) and is exceedingly rare in off- pump CABG. A 53-year-old man presented with unstable angina due to the severe stenosis of the left anterior descending coronary artery (LAD) and the obtuse marginal. Laboratory findings and Chest X-ray revealed nothing abnormal. The intraoperative course was uneventful. The patient left the operating room without any inotropic support. Six hours later, however, he developed low cardiac output. At exploration, cardiac tamponade was excluded and flowmetry showed that the graft had adequate function. Cardiac enzymes were normal. High-dose adrenalin and Dobutamine were administrated and an intra-aortic balloon pump was used. After hemodynamic stabilization, the patient left the Intensive Care Unit without an intra-aortic balloon pump and inotropic support. On the fifth postoperative day, coronary angiography showed patent grafts and correct anastomotic sites. On the seventh postoperative day, the akinetic lateral wall of the left ventricle changed to dyskinesia. Finally after hospital discharge on the thirtieth postoperative day, an echocardiogram showed normal left ventricular function without regional wall motion abnormalities.

Keywords: Coronary artery bypass grafting, off-pump; Myocardial stunning; Post-operative complication.

Figure 1.

Anteroposterior (AP) coronary angiography view showing patent left internal mammary artery (LIMA) to left anterior descending artery (LAD)

Figure 2.

Left lateral coronary angiography view showing patent saphenous vein graft (SVG) to left circumflex coronary artery (LCX)