Cardiogenic shock caused by acute occlusion of mammary artery bypass: successful treatment with primary angioplasty in the immediate postoperative period
Barbieri, E.; Frigiola, A.; Zardini, P.
Italian Heart Journal. Suppl Official Journal of the Italian Federation of Cardiology 3(2): 239-243
2002
ISSN/ISBN: 1129-4728 PMID: 11926034 Document Number: 545552
The early occlusion of a graft in the postoperative phase is not infrequent and is associated with high morbidity and mortality. A non-surgical solution, which is quick and effective, is an important achievement. A 65-year-old woman underwent myocardial revascularization. Three grafts were performed: left mammary artery to the left anterior descending coronary artery, saphenous vein to the right coronary artery and to the marginal branch. One hour after surgery, the patient developed progressive arterial hypotension which rapidly progressed to cardiogenic shock. The electrocardiogram showed anterior and lateral lesions. The angiogram revealed the occlusion of the first third of the left mammary artery. An angioplasty was performed in this vessel and in the left anterior descending coronary artery. The final angiogram showed good patency of the mammary artery and of the left anterior descending coronary artery. The hemodynamic conditions of the patient improved rapidly, with good pressure values. Primary angioplasty proved to be feasible in the early postoperative phase with good results; it could be a valid alternative to reoperation with lower morbidity and mortality.