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PP-172 GUILLAIN-BARRÉ SYNDROME AFTER CORONARY ARTERY BYPASS SURGERY
Poster Presentations / International Journal of Cardiology 163S1 (2013) S81–S211
To evaluate the mass further, a chest computed tomography with contrast injection was performed. This demonstrated a 89×118 mm aneurysm within the body of the bypass graft to the PDA (Figure 1 g, 1h). Surgery was offered to the patient taking into account the size and rapid progression of the aneurysm. Patient refused surgery and was managed conservatively. Saphenous vein graft (SVG) aneurysm is a rare and late complication of coronary artery bypass grafting (CABG). Prompt diagnosis requires a multimodality approach including computed tomography and coronary angiography. Optimal management is controversial where risk of rupture and thromboembolism should be weighted against risks of redo cardiac surgery. PP-171 A CASE OF MASSIVE EMBOLI DEVELOPING IN A PATIENT UNDERGOING SIMULTANEOUS PULMONARY THROMBOENDARTERECTOMY AND CORONARY BYPASS SURGERY A.F. Abacılar1 , F. Sever2 , I˙ .S. Uyar1 , M.B. Akpınar1 , V. Sahin1 , ¨ F.F. Okur1 , M. Ates¸ 1 , E.A. Alayunt1 . 1 Sifa ¸ Universitesi Kalp Damar ˙ ¨ Cerrahisi Ana Bilim Dalı, Izmir, Turkey; 2 Sifa ¸ Universitesi G¨ og˘ u ¨s ˙ hastalıkları Ana Bilim Dalı, Izmir, Turkey Among the reasons of pulmonary hypertension, chronic thromboembolic pulmonary hypertension is the only one which can be treated totally with surgery. Pulmonary thromboendarterectomy is the removal of the organized thrombus by peeling it from the pulmonary artery intima. Progressively increasing also in our country as all over the world. Although pulmonary thromboendarterectomy is a difficult surgical operation necessitating hypothermic circulatory arrest, the reported surgical mortality rates are around 10%. Our case who developed massive pulmonary emboli, while a coronary bypass operation was being planned for him, did not respond to thrombolitic therapy, therefore simultaneous pulmonary endarterectomy and coronary bypass operation were performed. We present this case to discuss the indications of pulmonary thromboendarterectomy, as well as the experiences about it.
Figure 1. Sa˘g ana pulmoner arterde trombus. ¨
S147
PP-172 GUILLAIN–BARRE´ SYNDROME AFTER CORONARY ARTERY BYPASS SURGERY F. Cingoz ¨ 1 , M. Tavlaso˘ ¸ glu2 , M. Kurkluoglu3 , M.A. Sahin1 . 1 Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey; 2 Department of Cardiovascular Surgery, Diyarbakir Military Medical Hospital, Diyarbakır, Turkey; 3 Department of Cardiovascular Surgery, Children’s National Heart Institute, Children’s National Medical Center, Washington, DC 20010, USA Introduction: The Guillain–Barre´ syndrome (GBS) is a frequent cause of neuromuscular paralysis occurring at all ages, and the incidence of GBS is reported to be 1.2–2.3 per 100 000 per year. GBS is a postinfectious disorder in which the most frequently identified infectious agent is Campylobacter jejuni. Others include cytomegalovirus, Mycoplasma pneumonia, Epstein–Barr virus and influenza virus. In addition, many reports have documented the occurrence of GBS shortly after vaccinations, operations or stressful events, but the causality and pathophysiology are still debated. In this article, we present the case of the GBS occurring in a 67-year old male patient after coronary artery bypass surgery. Methods: The patient was admitted to our cardiovascular surgery department after coronary angiography by means of critical stenosis of the LAD and diagonal arteries. The patient underwent off-pump cardiac surgery without any blood transfusion. Though perioperative and intraoperative periods remained uneventful, the patient noticed weakness and paresthaesia of his legs, which progressed rapidly on the postoperative second day. Subsequently, he was unable to stand on the same day. There was no history of toxin exposure, fever or other neurological diseases. Results: Physical examination revealed slight hypotonia, areflexia and loss of strength in all muscle groups in the legs. After neurology consultation, the possible diagnosis of Guillain–Barre´ was considered and confirmed by electromyography. The patient showed uneventful improvement after 5 days of plasmapheresis. Then the patient was discharged without sequela on the postoperative 10th day. Conclusion: The American Society for Apheresis completed an evidencebased review of 16 neurological indications of apheresis therapy and 10 were ranked as Category I or II. Category I denotes that the therapy is indicated as first-line treatment and Category II implies second-line treatment. GBS and chronic inflammatory demyelinating polyneuropathy were designated Category I. However, although apheresis therapy is designated Category I for GBS, the alternative treatment option is IVIG, because the treatment of GBS is centred on therapeutic plasma exchange or IVIG. In our case, we did not prefer the IVIG treatment because the patient did not need to be intubated. Hence, we think that it is not cost effective for the mild form of GBS due to its price. Although surgery may increase the incidence of GBS, the pathological process is still unclear. The GBS may be another neurological complication that may be very rarely encountered after cardiac surgery. PP-173 LEFT VENTRICULAR PSEUDOANEURYSM FORMATION DUE TO FREE WALL RUPTURE A.B. Durukan1 , H.A. Gurb ¨ uz ¨ 1 , M. Tavlaso˘ ¸ glu2 , N. Salman3 , 1 4 4 F.T. Serter , H. Ulubay , B. Diren , H.I. Ucar ¸ 1 , C. Yorgancıo˘glu1 . 1 Department of Cardiovascular Surgery, Medicana International Ankara Hospital, Ankara, Turkey; 2 Department of Cardiovascular Surgery, Diyarbakir Military Hospital, Diyarbakir, Turkey; 3 Department of Anesthesia, Medicana International Ankara Hospital, Ankara, Turkey; 4 Department of Radiology, Medicana International Ankara Hospital, Ankara, Turkey A 66 year old male patient admitted with chest pain on exertion. After physical examination and routine laboratory tests, coronary angiography was performed. Coronary angiography revealed
To evaluate the mass further, a chest computed tomography with contrast injection was performed. This demonstrated a 89×118 mm aneurysm within the body of the bypass graft to the PDA (Figure 1 g, 1h). Surgery was offered to the patient taking into account the size and rapid progression of the aneurysm. Patient refused surgery and was managed conservatively. Saphenous vein graft (SVG) aneurysm is a rare and late complication of coronary artery bypass grafting (CABG). Prompt diagnosis requires a multimodality approach including computed tomography and coronary angiography. Optimal management is controversial where risk of rupture and thromboembolism should be weighted against risks of redo cardiac surgery. PP-171 A CASE OF MASSIVE EMBOLI DEVELOPING IN A PATIENT UNDERGOING SIMULTANEOUS PULMONARY THROMBOENDARTERECTOMY AND CORONARY BYPASS SURGERY A.F. Abacılar1 , F. Sever2 , I˙ .S. Uyar1 , M.B. Akpınar1 , V. Sahin1 , ¨ F.F. Okur1 , M. Ates¸ 1 , E.A. Alayunt1 . 1 Sifa ¸ Universitesi Kalp Damar ˙ ¨ Cerrahisi Ana Bilim Dalı, Izmir, Turkey; 2 Sifa ¸ Universitesi G¨ og˘ u ¨s ˙ hastalıkları Ana Bilim Dalı, Izmir, Turkey Among the reasons of pulmonary hypertension, chronic thromboembolic pulmonary hypertension is the only one which can be treated totally with surgery. Pulmonary thromboendarterectomy is the removal of the organized thrombus by peeling it from the pulmonary artery intima. Progressively increasing also in our country as all over the world. Although pulmonary thromboendarterectomy is a difficult surgical operation necessitating hypothermic circulatory arrest, the reported surgical mortality rates are around 10%. Our case who developed massive pulmonary emboli, while a coronary bypass operation was being planned for him, did not respond to thrombolitic therapy, therefore simultaneous pulmonary endarterectomy and coronary bypass operation were performed. We present this case to discuss the indications of pulmonary thromboendarterectomy, as well as the experiences about it.
Figure 1. Sa˘g ana pulmoner arterde trombus. ¨
S147
PP-172 GUILLAIN–BARRE´ SYNDROME AFTER CORONARY ARTERY BYPASS SURGERY F. Cingoz ¨ 1 , M. Tavlaso˘ ¸ glu2 , M. Kurkluoglu3 , M.A. Sahin1 . 1 Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey; 2 Department of Cardiovascular Surgery, Diyarbakir Military Medical Hospital, Diyarbakır, Turkey; 3 Department of Cardiovascular Surgery, Children’s National Heart Institute, Children’s National Medical Center, Washington, DC 20010, USA Introduction: The Guillain–Barre´ syndrome (GBS) is a frequent cause of neuromuscular paralysis occurring at all ages, and the incidence of GBS is reported to be 1.2–2.3 per 100 000 per year. GBS is a postinfectious disorder in which the most frequently identified infectious agent is Campylobacter jejuni. Others include cytomegalovirus, Mycoplasma pneumonia, Epstein–Barr virus and influenza virus. In addition, many reports have documented the occurrence of GBS shortly after vaccinations, operations or stressful events, but the causality and pathophysiology are still debated. In this article, we present the case of the GBS occurring in a 67-year old male patient after coronary artery bypass surgery. Methods: The patient was admitted to our cardiovascular surgery department after coronary angiography by means of critical stenosis of the LAD and diagonal arteries. The patient underwent off-pump cardiac surgery without any blood transfusion. Though perioperative and intraoperative periods remained uneventful, the patient noticed weakness and paresthaesia of his legs, which progressed rapidly on the postoperative second day. Subsequently, he was unable to stand on the same day. There was no history of toxin exposure, fever or other neurological diseases. Results: Physical examination revealed slight hypotonia, areflexia and loss of strength in all muscle groups in the legs. After neurology consultation, the possible diagnosis of Guillain–Barre´ was considered and confirmed by electromyography. The patient showed uneventful improvement after 5 days of plasmapheresis. Then the patient was discharged without sequela on the postoperative 10th day. Conclusion: The American Society for Apheresis completed an evidencebased review of 16 neurological indications of apheresis therapy and 10 were ranked as Category I or II. Category I denotes that the therapy is indicated as first-line treatment and Category II implies second-line treatment. GBS and chronic inflammatory demyelinating polyneuropathy were designated Category I. However, although apheresis therapy is designated Category I for GBS, the alternative treatment option is IVIG, because the treatment of GBS is centred on therapeutic plasma exchange or IVIG. In our case, we did not prefer the IVIG treatment because the patient did not need to be intubated. Hence, we think that it is not cost effective for the mild form of GBS due to its price. Although surgery may increase the incidence of GBS, the pathological process is still unclear. The GBS may be another neurological complication that may be very rarely encountered after cardiac surgery. PP-173 LEFT VENTRICULAR PSEUDOANEURYSM FORMATION DUE TO FREE WALL RUPTURE A.B. Durukan1 , H.A. Gurb ¨ uz ¨ 1 , M. Tavlaso˘ ¸ glu2 , N. Salman3 , 1 4 4 F.T. Serter , H. Ulubay , B. Diren , H.I. Ucar ¸ 1 , C. Yorgancıo˘glu1 . 1 Department of Cardiovascular Surgery, Medicana International Ankara Hospital, Ankara, Turkey; 2 Department of Cardiovascular Surgery, Diyarbakir Military Hospital, Diyarbakir, Turkey; 3 Department of Anesthesia, Medicana International Ankara Hospital, Ankara, Turkey; 4 Department of Radiology, Medicana International Ankara Hospital, Ankara, Turkey A 66 year old male patient admitted with chest pain on exertion. After physical examination and routine laboratory tests, coronary angiography was performed. Coronary angiography revealed