Criss Benjamin E, Zimmermann Nives, Butler Randall T
Department of Pathology and Laboratory Medicine, UC Health University Hospital Laboratory Medicine Building, Suite 110, 234 Goodman Street, Cincinnati, OH, 45219-0533.
J Forensic Sci. 2019 Jan;64(1):281-283. doi: 10.1111/1556-4029.13844. Epub 2018 Jun 25.
Traditionally, the manner of death in most hospital autopsy cases is natural, in which death is due to the natural course of disease or reasonably anticipated outcomes of medical interventions. Some cases fall into a potential gray zone between natural and accident, including rare or unanticipated outcomes of medical interventions. We present a case of a patient postcoronary artery bypass graft. Autopsy revealed the proximal anastomosis of the aorta-to-first-diagonal-coronary-artery-to-second-obtuse-marginal-artery graft was detached from the aorta. A broken suture was present at the disconnected anastomosis, with intact knots but was broken along its length. In-hospital mortality rates of CABG range from 1% to 3%, with several autopsy studies identifying surgical complications as the cause of death in one-third of perioperative deaths. No publications were found that described suture rupture as directly relating to the cause of death. This case report describes a previously unreported complication of coronary artery bypass grafting.
传统上，大多数医院尸检病例的死亡方式为自然死亡，即死亡是由疾病的自然进程或医疗干预的合理预期结果导致的。有些病例处于自然死亡和意外死亡之间的潜在灰色地带，包括医疗干预的罕见或意外结果。我们报告一例冠状动脉旁路移植术后患者的病例。尸检显示，主动脉至第一对角冠状动脉至第二钝缘支动脉移植血管的近端吻合口与主动脉分离。在断开的吻合口处有一根缝线断裂，结是完整的，但缝线沿其长度断裂。冠状动脉旁路移植术的院内死亡率在1%至3%之间，多项尸检研究确定手术并发症是三分之一围手术期死亡的原因。未发现有出版物将缝线断裂描述为直接与死亡原因相关。本病例报告描述了一种此前未报告的冠状动脉旁路移植术并发症。
