Peculiariities of diagnostic parameters in patients with acute myocardial lesion after coronary artery bypass grafting

Semagin A.A.^1,2, Lukin O.P.^1,2, Shaldybin P.D.², Fokin A.A.²

1) Cardiosurgical Department № 2, Federal Centre of Cardiovascular Surgery,
2) Department of Surgery of the Institute of Additional Professional Education, South Ural State Medical University under the RF Ministry of Public Health, Chelyabinsk, Russia

Annually, up to 850 000 coronary aortic bypass graft operations are performed worldwide. Despite modern technical equipment ensuring a high level of safety of the procedure, currently important remains a problem related to intraoperative myocardial damage in using artificial circulation. Early detection and clinical assessment of myocardial ischaemia often present a difficult task.

This article deals with clinical, instrumental and laboratory methods of diagnosis, aimed at verification of an intraoperative cardiac lesion associated with graft dysfunction in coronary artery bypass grafting. Isolated electrocardiographic and echocardiographic signs of myocardial ischaemia between the comparison groups did not differ significantly. Analysing the markers of myocardial lesions, statistically significant differences were obtained only after 48 hours which, from the point of view of saving viable myocardium, is an utterly long-term interval. Studying the findings of intraoperative flowmetry showed statistically significant dependence between velocity characteristics, pulse index of shunts and their patency on angiographic examination. Thus, only combination of diagnostic parameters makes it possible to detect myocardial damage related to shunt dysfunction. This enables early determination of indications for performing bypass angiography and selection of the required therapeutic policy. Timely coronary artery angiography makes it possible to reveal defects of shunts and to timely perform surgical correction, preventing myocardial infarction.

KEY WORDS: coronary artery bypass grafting, perioperative myocardial infarction, coronary bypass angiography, Troponin I, flowmetry.

P. 120

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