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New ST-Segment Elevation After Coronary Artery Bypass: A Case Report

Author : N. O. H. Rantung, L. A. Natalino, V. Sariowan, A. E. Haurissa, A. Tangkilisan, H. Abraham, J.A. Pang
Upload Date : 19-04-2018

Background: Postoperative myocardial infarction remains a significant problem and carries a very high morbidity and mortality in patients undergoing CABG. The 12-lead postoperative ECG is commonly used to identify patients with postoperative myocardial infarction.

Case report: A 61 years old male was admitted to hospital electively for CABG. He was diagnosed with CAD 3 VD + LM and hypertension. The echocardiography and Doppler vascular examination within normal limits. During the CABG the surgeon performed OPCAB 2 graft. The LIMA was grafted to the proximal LCX and SVG to distal LAD. 1 hour after the surgery the blood pressure dropped to 70/40 mmHg and heart rate 75 bpm. The ECG examination showing ST segment elevation at aVR and ST segment depression at I, II, aVF, V2-V5. TEE was done immediately showing a akinetic wall movement on anterior, mid-basal anteroseptal, antero lateral, lateral, apical, apicoseptal. Resuscitation was done immediately and the patient was planned to redo CABG.

Discussion: Postoperative myocardial ischemia is rare but serious complication of CABG. Incorrect graft anastomosis, graft spasm, displacement and dissection, coronary artery thrombosis and incomplete revascularization are main causes.

Conclusion: New ST-segment elevation, if seen within the first few hours after CABG, may be an indication of postoperative myocardial infarction or of intermittent myocardial ischemia due to coronary artery spasm or mechanical factors compromising one or more bypass grafts. Although there is a chance of postoperative myocardial injury happens, still CABG remains an established form of treatment for coronary artery disease.

KEYWORDS : New ST-segment elevation, CABG, myocardial infarction.

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