Intraoperative diagnosis and successful management of acute coronary–subclavian steal syndrome during off-pump coronary artery bypass grafting: a case report - Report - MDSpire
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Intraoperative diagnosis and successful management of acute coronary–subclavian steal syndrome during off-pump coronary artery bypass grafting: a case report
Clinical Report: Intraoperative Identification and Treatment of CSSS During CABG
Overview
This report details a rare case of acute coronary-subclavian steal syndrome (CSSS) occurring intraoperatively during off-pump coronary artery bypass grafting (CABG). The condition was diagnosed using transit-time flow measurement and successfully treated with immediate LIMA graft reconstruction.
Background
Coronary-subclavian steal syndrome (CSSS) is a serious complication that can occur after CABG, particularly when there is significant stenosis of the left subclavian artery. This condition can lead to myocardial ischemia due to reversed blood flow in the left internal mammary artery (LIMA). Intraoperative identification of CSSS is exceptionally rare, making this case significant for surgical practice.
Acute CSSS can occur intraoperatively during CABG, leading to myocardial ischemia.
Transit-time flow measurement (TTFM) is effective for diagnosing CSSS in real-time.
Immediate surgical intervention, such as LIMA graft reconstruction, can restore normal blood flow.
Postoperative recovery can be stable with appropriate management, including IABP support.
Monitoring cardiac biomarkers is crucial for assessing myocardial injury during and after surgery.
Clinical Implications
This case emphasizes the importance of intraoperative flow evaluation to identify rare complications like CSSS. Surgeons should maintain a high index of suspicion for CSSS in patients undergoing CABG, particularly those with known subclavian artery stenosis.
Conclusion
Intraoperative identification and management of CSSS are critical for preventing serious complications during CABG. This case highlights the need for vigilant monitoring and prompt surgical response.
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