CASE REPORTS  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2001 June;42(3):349-51

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Coronary artery bypass grafting in a patient with brainstem ischemia

Tsukube T., Okada M., Ataka K., Ozaki N.

From the Department of Surgery, Division II Kobe University, School of Medicine Kobe, Japan

We ­describe a 54-­year-old ­male ­with ­severe cor­o­nary ­artery dis­ease and cereb­ro­vas­cular dis­ease ­including ­right cer­e­bellar infarc­tion, ­total occlu­sion of the bilat­eral ver­te­bral ­arteries, brain­stem ­ischemia, and ­right cere­bral infarc­tion ­with sig­nif­i­cant ­right ­carotid ­artery dis­ease. ­Repeated per­cut­aneous trans­lu­minal cor­o­nary angio­plasty had ­been per­formed, how­ever, ­unstable ­angina was devel­oped ­despite max­imal med­ical treat­ment. Cor­o­nary ­artery ­bypass ­grafting was suc­cess­fully under­gone ­with use of pro­pofol, appli­ca­tion of the ­intra-­aortic bal­loon ­pumping per­i­op­er­a­tively, and ­mild hypo­thermic car­di­o­pul­mo­nary ­bypass ­with ­alpha-­stat ­blood gas man­age­ment. The impor­tance of pre­op­er­a­tive eval­u­a­tion of the intra­cra­nial cir­cu­la­tion and man­age­ment of car­di­o­pul­mo­nary ­bypass are dis­cussed.