Near-fatal kinking of mammary graft due to emphysematous lung disease.

Autor:	Denny JT; Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Mungekar S; Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Landgraf BR; Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., McRae VA; Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Ibrar S; Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Kiss GK; Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Bonitz J; Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Cohen S; Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Tse JT; Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Jazyk:	angličtina
Zdroj:	SAGE open medical case reports [SAGE Open Med Case Rep] 2018 Mar 28; Vol. 6, pp. 2050313X18767228. Date of Electronic Publication: 2018 Mar 28 (Print Publication: 2018).
DOI:	10.1177/2050313X18767228
Abstrakt:	Left internal mammary artery grafting is commonly used in elective coronary artery bypass graft surgery. We report a near-fatal case with graft kinking upon sternal closure due to distended, emphysematous lungs impinging on the mammary graft. After the sternum was closed, the patient suffered a severe hemodynamic deterioration. Surgical examination revealed kinking of his left internal mammary artery upon sternal closure due to distended, emphysematous lungs impinging on the mammary graft. Using an off-bypass technique, the kink in the mammary graft to the left anterior descending artery was removed by moving the origin of the left internal mammary artery to a hooded graft of a saphenous vein graft instead. In this position, the graft no longer was impinged upon by the distended emphysematous lungs. Subsequently, the patient's sternum was closed without hemodynamic impingement. Although chronic obstructive pulmonary disease is well described to increase complications in coronary artery bypass graft surgery, it has not been previously associated with the kinking of a left internal mammary artery. This report highlights another contribution that chronic obstructive pulmonary disease can make to increased morbidity following coronary artery bypass graft surgery and alerts readers to watch for this complication in susceptible patients. Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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