Heart Rescue in Acute Left Main Coronary Artery Occlusion with CABG Using Initial Retrograde Perfusion

Acute occlusion of the left main coronary artery (LMCA) is a rare and almost invariably fatal condition. Here, we report on heart salvage in two such cases with CABG aided by emergent retrograde reperfusion as the initial operative step. Both cases were extremely unusual. The first patient had twice survived LMCA occlusion; the second also had right coronary artery occlusion. We will also review the literature on acute LMCA occlusion and coronary venous retroperfusion.

Left main coronary artery occlusion - Myocardial ischemia - Coronary sinus - Myocardial protection - Coronary surgery

References

• 1 Spiecker M, Erbel R, Rupprecht H J, Meyer J. Emergency angioplasty of totally occluded left main coronary artery in acute myocardial infarction and unstable angina pectoris-institutional experience and literature review.  Eur Heart J. 1994;  15 602-607
• 2 Iwasaki K, Kusachi S, Hina K. et al . Acute left main coronary artery obstruction with myocardial infarction-reperfusion strategies, and the clinical and angiographic outcome.  Jap Circ J. 1993;  57 891-897
• 3 Zahn R, Schneider M, Schuster S. et al . [Direct dilatation and emergency bypass operation of main branch occlusion in acute anterior wall infarct and cardiogenic shock]. [German].  Herz. 1997;  22 111-115
• 4 Itoh T, Fukami K, Oriso S. et al . Survival following cardiogenic shock caused by acute left main coronary artery total occlusion. A case report and review of the literature.  Angiology. 1997;  48 163-171
• 5 Sakurai Y, Mizuhara H, Matsuda K, Nakatani T, Sasako Y, Kitamura S. [A case report of emergent CABG after left main trunk occlusion as complication of direct PTCA]. [Japanese].  Kyobu Geka - Jap J Thorac Surg. 1999;  52 639-643
• 6 Orrego P S, Pezzano A, Muriesan H, Belli G, Klugmann S. A rare case: surviving acute left main coronary artery occlusion in Kawasaki's disease.  Giornale Italiano di Cardiologia. 1999;  29 1323-1326
• 7 Lijoi A, Della R F, Passerone G C. et al . Emergency surgical treatment for total left main coronary artery occlusion. A report of 2 cases.  Texas Heart Institute Journal. 1993;  20 55-58
• 8 Read R C, DeWall R A, Warden H E, Walton Lillehei C. The application of arterialized venous blood to intracardiac surgery.  Surg Gynecol Obstetr. 6 - 6-1957;  104 457-462
• 9 Wakida Y, Nordlander R, Kobayashi S, Kar S, Haendchen R, Corday E. Short-term synchronized retroperfusion before reperfusion reduces infarct size after prolonged ischemia in dogs.  Circulation. 1993;  88 2370-2380
• 10 Kar S, Drury J K, Hajduczki I. et al . Synchronized coronary venous retroperfusion for support and salvage of ischemic myocardium during elective and failed angioplasty.  J Am Coll Cardiol. 1991;  18 271-282
• 11 Lazar H L, Haan C K, Yang X, Rivers S, Bernard S, Shemin R J. Reduction of infarct size with coronary venous retroperfusion.  Circulation. 1992;  86 II 352-II 357
• 12 Slogoff S, Keats A S. Does perioperative myocardial ischemia lead to postoperative myocardial infarction?.  Anesthesiology. 1985;  62 107-114
• 13 Svedjeholm R, Håkanson E, Forsman M. Treatment of acute myocardial ischemia during early stages of surgery by an easily applicable method for emergency retroperfusion.  Eur J Cardio-Thorac Surg. 1999;  15 551-552
• 14 Bedi H S, Suri A, Kalkat M S. et al . Global myocardial revascularization without cardiopulmonary bypass using innovative techniques for myocardial stabilization and perfusion.  Ann Thorac Surg. 2000;  69 156-164
• 15 Buckberg G D. When is cardiac muscle damaged irreversibly?.  J Thorac Cardiovasc Surg. 1986;  92 483-487
• 16 Allen B S, Okamoto F, Buckberg G D. et al . Immediate functional recovery after six hours of regional ischemia by careful control of conditions of reperfusion and composition of reperfusate.  J Thorac Cardiovasc Surg. 1986;  92 621-635
• 17 Beyersdorf F, Kirsh M, Buckberg G D, Allen B S. Warm glutamate/aspartate-enriched blood cardioplegic solution for perioperative sudden death.  J Thorac Cardiovasc Surg. 1992;  104 1141-1147