Vessel Disease Of Coronary Artery Research Articles

ELECTRICAL STORM FOLLOWING CORONARY ARTERY BYPASS GRAFTING IN A PATIENT WITH HYPERTHYROIDISM: A CASE REPORT

An electrical storm, dened as repeated ventricular arrhythmia has been reported as a relatively rare but challenging event. We report a case of an electrical storm following coronary artery bypass grafting (CABG) surgery in a 49-year-old man with untreated hyperthyroidism. The patient underwent successful CABG surgery after being diagnosed with ST elevation myocardial infarction and three vessel disease of coronary artery. Six days after the operation, ventricular tachy-arrhythmias were continuously observed, and direct current cardioversions were performed more than 30 times over 24 hours. Based on laboratory test results, the patient had persistent hyperthyroidism, and we continued anti- thyroid therapy and anti-arrhythmic medication. Eventually, the patient was successfully treated with a second trial of catheter ablation. In conclusion, physicians must carefully manage thyroid function in patients undergoing cardiac surgery. We also recommend that cardiac surgery teams take a multidisciplinary perioperative approach to critical care for cardiac surgery.

The result of emergency cardiac intervention in resuscitated out-of-hospital cardiac arrest patients

Background: Arrhythmia and sudden cardiac decompensation (acute myocardial infarct or acute heart failure) are the most often causes of out-of-hospital cardiac arrest (OHCA). Emergency cardiac catheterization followed by coronary revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting surgery [CABG]) or valvular surgery is a lifesaving procedure. However, the result of this emergency room resuscitated OHCA patients underwent cardiac invasive procedure was not well defined before. Materials and Methods: One hundred and seventy (including 23 traumatic and stroke, etc.,) out of 705 OHCA patients were resuscitated and achieved a return of spontaneous circulation (ROSC) at Emergency Room of Chung Shan Medical University Hospital from January 1, 2011, to March 31, 2015. Only 23 (M/F = 25/8) out of 147 medically resuscitated OHCA patient with one or more cardiac risk factors were transferred for emergency cardiac catheterization (33/147). Thirty-one of them (31/33) underwent PCI (either balloon angioplasty or stent deployment) with coronary culprit stenotic lesions (>70%) of right coronary artery (15), left anterior descending artery (12), circumflex branch of left coronary artery (5), and left main coronary artery (1). One of the rest two patients with aortic valvular stenosis who underwent aortic valve replacement; and another with triple vessel disease of coronary artery received CABG. Results: All 33 patients (22.4%) survived the catheterization procedures and were sent to intensive care units. 31 patients were in comatose state and 24 eventually deceased due to cardiogenic shock (16), septic shock (4), ventricular tachycardia and ventricular fibrillation (2), hyperkalemia (1) and multiple organ failure (1). Nine patients (27.3%) survived to hospital discharge and were followed up at OPD periodically (1.3–43 months, mean 30.4 months). Four OHCA patients required extra-corporeal membrane oxygenation support, but only one out of four underwent PCI and survived. Conclusions: The resuscitated OHCA (ROSC) patients with any cardiac disease in the past should undergo emergency cardiac catheterization and possible intervention procedure with an acceptable result (survival to hospital discharge rate of 27.3%).

Bail-Out of Drug-Refractory VF Electrical Storm in a Patient Who Underwent Percutaneous Coronary Intervention for Three Vessel Disease

Although the prolonged QT interval in a patient with acute coronary syndrome is a predicting factor of lethal ventricular tachyarrhythmia, the relation between revascularization of coronary artery and QT interval is not clear. A 64-year-old man was admitted to the hospital because of congestive heart failure and drug-refractory ventricular fibrillation electrical storm . Emergency coronary angiography showed three vessel disease of coronary artery. Percutaneous coronary intervention (PCI) was performed for the culprit lesion of left anterior descending artery and revascularized LAD region successfully. However Vf-ES recurred 12 hours after LAD intervention. Therefore, the second PCI was performed for the narrowing of RCA and total occlusion of LCX. Then complete revascularization was obtained. No ventricular tachyarrhythmia was observed after the second procedure. In this patient, QT interval, QT dispersion and Tpeak-end changed dramatically before and after revascularization. The QT interval, QT dispersion, Tpeak-end were 620 msec, 70 msec, 178 msec before PCI, 621 msec, 98 msec, 156 msec after first procedure, and 400 msec, 100 msec, 116 mses after 2nd procedure. The shortening of QT interval and Tpeak-end may be related to complete revascularization and suppression of Vf-ES.

754 Assessment of myocardial perfusion in patients with triple vessel disease of coronary artery using quantitative real-time myocardial contrast echocardiography

754 Assessment of myocardial perfusion in patients with triple vessel disease of coronary artery using quantitative real-time myocardial contrast echocardiography