Makuuchi H, Fuse K, Konishi T
Division of Cardiovascular Surgery, Toranomon Hospital, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1991 May;92(5):587-91.
Among 535 cases of simple CABG, cerebral infarction was complicated in 5 cases (0.9%). Their mean age (65.2 years old) was high, and 80% of them had the history of hypertension or diabetes mellitus or both. The causes of the cerebral infarction were considered to be the embolism of atheromatous debris from the ascending aorta (3 cases), the cerebral hypoperfusion due to cerebral arterial disease and hypotension during cardiopulmonary bypass (1 cases), and the embolism of the left atrial thrombus formed during repeated supraventricular tachyarrhythmias (1 case). Both cases of the multiple infarctions were lost in-hospital 10 months and 21 months postoperatively. Two of the three cases of single infarction suffered from the permanent neurological deficits. To prevent cerebral infarction which might totally deprive of the efficacy of the CABG, it is important to check and properly manage the atheromatous change of the ascending aorta, the cerebral arterial disease, and also postoperative supraventricular tachyarrhythmias.
在535例单纯冠状动脉旁路移植术（CABG）病例中，有5例（0.9%）并发脑梗死。他们的平均年龄较高（65.2岁），其中80%有高血压或糖尿病史或两者皆有。脑梗死的原因被认为是升主动脉粥样斑块碎片栓塞（3例）、体外循环期间由于脑动脉疾病和低血压导致的脑灌注不足（1例）以及反复室上性快速心律失常期间形成的左心房血栓栓塞（1例）。两例多发性梗死患者分别于术后10个月和21个月住院期间死亡。三例单发性梗死中有两例出现永久性神经功能缺损。为预防可能完全剥夺CABG疗效的脑梗死，检查并妥善处理升主动脉的粥样硬化改变、脑动脉疾病以及术后室上性快速心律失常非常重要。
