ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Ann Thorac Surg 2009;87:e15. doi:10.1016/j.athoracsur.2008.11.024
© 2009 The Society of Thoracic Surgeons
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Hauw T. Sie
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Heestermans, T. M.
Right arrow Articles by Sie, H. T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Heestermans, T. M.
Right arrow Articles by Sie, H. T.
Related Collections
Right arrow Coronary disease
Right arrow Myocardial infarction

Images in Cardiothoracic Surgery

Immediate Myocardial Infarction due to Compression of a Vein Graft

Ton M. Heestermans, MDa,*, Jan-Henk E. Dambrink, MD, PhDa, Hauw T. Sie, MDb

a Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
b Department of Cardiothoracic Surgery, Isala Klinieken, Zwolle, the Netherlands

* Address correspondence to Dr Heestermans, Isala Klinieken, locatie Weezenlanden, Department of Cardiology, Groot Wezenland 20, Zwolle, 8011 JW, the Netherlands (Email: v.r.c.derks{at}isala.nl).

A 72-year-old woman with hypertension and hypercholesterolemia presented with complaints of chest pain and dyspnea (New York Heart Association classification III/IV). The results of the resting electrocardiogram (ECG) were normal; however, exercise testing was suggestive for ischemia. Diagnostic catheterization confirmed 3-vessel disease with preserved left ventricular function.

The patient underwent coronary artery bypass grafting using the left internal mammary artery to the left anterior descending artery and a venous jump graft with four distal anastomoses. The procedure was uneventful.

The patient was weaned off bypass smoothly, and one pleural drain and one pericardial drain were left behind before closure of the chest. The postoperative ECG (Fig 1C) demonstrated ST-segment elevation in leads II, III, and aVF, and ST-segment depression in V1 through V3 suggestive of an acute inferoposterolateral myocardial infarction.


Figure 1
View larger version (87K):
[in this window]
[in a new window]

  		Fig 1.
 
Emergency angiography demonstrated thrombolysis in myocardial infarction (TIMI) II flow in the venous jump graft caused by external compression of the venous jump graft by the pleura drain (Fig 1A). After removal of the drain, flow was restored to TIMI III (Fig 1B), and the ECG demonstrated resolution of the ST-segment elevation (Fig 1D).

The lesson to be learned from this incident is that care needs to be taken when drains are placed and the sternum is closed. Even a relatively minor detail such as chest drain position can have a major effect on the patient's postoperative course. Early recognition of these kinds of mechanical problems is a matter of common sense, but is extremely important, and should be followed by immediate and adequate intervention.


   Acknowledgments
Top
 Acknowledgments
 
We thank Hilde Woudstra for the preparation of the images.




This article has been cited by other articles:


Home page
 QJMHome page
N. N. Lang and D. E. Newby
Cardiac compression causing fatal acute ST-segment elevation myocardial infarction
QJM, July 30, 2011; (2011) hcr131v1.
[Full Text] [PDF]

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Hauw T. Sie
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Heestermans, T. M.
Right arrow Articles by Sie, H. T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Heestermans, T. M.
Right arrow Articles by Sie, H. T.
Related Collections
Right arrow Coronary disease
Right arrow Myocardial infarction

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS