Abstract
BackgroundEarly postoperative stroke is an adverse syndrome after coronary bypass surgery. This report focuses on overcoming of cerebral ischemia as a result of haemodynamic instability during heart enucleation in off-pump procedure.Case presentationA 67 year old male patient, Caucasian race, with a body mass index of 28, had a recent non-Q posterolateral myocardial infarction one month before and recurrent instable angina. His past history includes an uncontrolled hypertension, dyslipidemia, insulin dependent diabetes mellitus, epiaortic vessel stenosis. The patient was scheduled for an off-pump procedure and monitored with bilateral somatosensory evoked potentials, whose alteration signalled the decrement of the cardiac index during operation.The somatosensory evoked potentials appeared when the blood pressure was increased with a pharmacological treatment.ConclusionDuring the off-pump coronary bypass surgery, a lower cardiac index, predisposes patients, with multiple stroke risk factors, to a reduction of the cerebral blood flow. Intraoperative somatosensory evoked potentials monitoring provides informations about the functional status of somatosensory cortex to reverse effects of brain ischemia.
Highlights
Postoperative stroke is an adverse syndrome after coronary bypass surgery
A 67 year old male patient, Caucasian race, body mass index of 28, with two-vessel disease not amenable to angioplasty, was scheduled for an off-pump procedure, consisting in a left internal mammary artery graft on anterior descending coronary artery and venous grafts on the obtuse marginal. His medical history included one month before, a non-Q posterolateral myocardial infarction and recurrent instable angina; complete occlusion of the right internal carotid and left vertebral artery and 50% stenosis of the left internal carotid artery; uncontrolled hypertension; dyslipidemia, and insulin dependent diabetes mellitus complicated with lower limb sensory neuropathy
The Somatosensory evoked potentials (SEPs) and the hemodynamic parameters did not change until the end of the first graft
Summary
Case presentation: A 67 year old male patient, Caucasian race, with a body mass index of 28, had a recent non-Q posterolateral myocardial infarction one month before and recurrent instable angina His past history includes an uncontrolled hypertension, dyslipidemia, insulin dependent diabetes mellitus, epiaortic vessel stenosis. A 67 year old male patient, Caucasian race, body mass index of 28, with two-vessel disease not amenable to angioplasty, was scheduled for an off-pump procedure, consisting in a left internal mammary artery graft on anterior descending coronary artery and venous grafts on the obtuse marginal His medical history included one month before, a non-Q posterolateral myocardial infarction and recurrent instable angina; complete occlusion of the right internal carotid and left vertebral artery and 50% stenosis of the left internal carotid artery; uncontrolled hypertension; dyslipidemia, and insulin dependent diabetes mellitus complicated with lower limb sensory neuropathy. The patient had suffered a stroke because of closing right carotid artery, without clinical effects
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