Acute myocardial infarction due to thrombolytic reperfusion of chronically occluded saphenous vein coronary bypass grafts

Myocardial injury during reoperation for coronary artery bypass surgery

OBJECTIVES

To determine the incidence, triggers, and timing of myocardial injury during reoperation for coronary artery bypass surgery.

DESIGN

Prospective observational.

SETTING

One tertiary care university hospital.

PARTICIPANTS

15 patients undergoing reoperation.

INTERVENTIONS

Multilead electrocardiographic monitoring approximately every 3 minutes during surgery.

MEASUREMENTS AND MAIN RESULTS

The occurrence of a new ischemic ST elevation or depression on the electrocardiogram (ECG) was determined. A major deterioration in ventricular function after cardiopulmonary bypass (CPB) also was determined. Peak creatine kinase myocardial band (CK-MB) > or = 25 IU/L was considered to be the marker of myocardial injury. Seven patients demonstrated myocardial injury, all intraoperatively. Five of these patients had new ST elevation episodes before CPB. Three of the episodes were temporally associated with an abrupt increase in the heart rate. The other two episodes were temporally associated with surgical manipulation of the heart and the old grafts. The sixth patient had a significant deterioration of ventricular function during CPB. One of the patients who had ST elevation before CPB and the seventh patient developed ST elevation towards the end of protamine administration.

CONCLUSIONS

In patients undergoing reoperation, the intraoperative incidence of myocardial injury, especially before CPB, was found to be substantially higher than that previously reported.

Intracerebral hemorrhage complicating urokinase infusion into an occluded aortocoronary bypass graft

Selective infusion of urokinase into occluded coronary bypass vein grafts is effective in restoring patency. We report the occurrence of intracerebral hemorrhage complicating an intra-graft urokinase infusion protocol. The patient had known cerebral vascular structural pathology without recent clinical complications. Caution with the use of thrombolysis in this setting is suggested.

Coronary thrombus: a novel catheter-based approach to treatment

The presence of coronary thrombus during intracoronary interventions increases the risk of complications during the procedure. We describe a novel approach to infusing thrombolytic agents selectively into a coronary artery utilizing a new low-profile perfusion balloon. This approach may add a useful new treatment for resistant intracoronary thrombi.

Acute myocardial infarction complicating urokinase infusion for total saphenous vein graft occlusion

Saphenous vein graft occlusions have been successfully treated with extended urokinase infusions. We report a case of myocardial infarction complicating this treatment. A review of reported cases suggests that this complication may not be uncommon. The optional drug, dose, and infusion technique for intra-graft lytic therapy has not been determined. The costs, risks, and difficulty of this technique may limit its application.