Caldeira C C, Char E A, Caldeira A S, Moreno-Cabral C E, McNamara J J
Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu 96813, USA.
Jpn Circ J. 1997 Dec;61(12):1011-4. doi: 10.1253/jcj.61.1011.
The use of the internal mammary artery (IMA) in coronary artery bypass surgery has increased substantially over the past 20 years, being at present the conduit of choice for most patients. Complications associated with its use occur occasionally and include life-threatening postoperative ischemia or the revascularized myocardium. We reviewed the records of 1,971 consecutive patients who underwent coronary artery bypass grafting over a 5-year period. All operations included an IMA graft to the left anterior descending coronary artery. Twenty-eight of these patients (1.4%) underwent additional placement of a vein graft on the same region as a salvage maneuver for suspected hypoperfusion as a result of IMA failure. All 28 patients showed life-threatening hemodynamic compromise. Twenty-two of the 28 patients (79%) survived. This was the result of immediate surgical correction, which reversed their hemodynamic instability. IMA hypoperfusion was found more frequently in reoperations and in women and diabetic patients. This syndrome is the result of an imbalance between IMA flow and myocardial demand, causing sudden and unexpected myocardial failure. Its detection and expeditious treatment can successfully modify a serious and potentially lethal clinical situation.
在过去20年里，冠状动脉旁路移植术中乳内动脉（IMA）的使用显著增加，目前它是大多数患者的首选血管桥。与使用IMA相关的并发症偶尔会发生，包括危及生命的术后缺血或再血管化心肌。我们回顾了连续5年接受冠状动脉旁路移植术的1971例患者的记录。所有手术均包括将IMA移植至左前降支冠状动脉。其中28例患者（1.4%）因怀疑IMA功能衰竭导致灌注不足，作为挽救措施在同一区域额外植入了静脉桥。所有28例患者均出现危及生命的血流动力学损害。28例患者中有22例（79%）存活。这是立即进行手术纠正的结果，手术纠正逆转了他们的血流动力学不稳定。IMA灌注不足在再次手术患者以及女性和糖尿病患者中更常见。该综合征是IMA血流与心肌需求之间失衡的结果，导致突然且意外的心肌衰竭。对其进行检测并迅速治疗可成功改善严重且可能致命的临床状况。
