Off-Pump Coronary Artery Bypass (OPCAB) for Acute LMCA - LAD Dissection due to Blunt Chest Trauma: A Case Study

Case Report

Austin J Surg. 2017; 4(2): 1100.

Off-Pump Coronary Artery Bypass (OPCAB) for Acute LMCA - LAD Dissection due to Blunt Chest Trauma: A Case Study

Gopal R¹, Nebhu MS¹, Mohamed AA³ and Jalal MJA4*

¹Department of Cardio-Thoracic and Vascular Surgery, VPS Lakeshore Hospital, India

²Department of Accident and Emergency Medicine, VPS Lakeshore Hospital, India

³Department of Internal Medicine and Rheumatology, VPS Lakeshore Hospital, India

*Corresponding author: Jalal MJA, Department of Internal Medicine and Rheumatology, VPS Lakeshore Hospital, India

Received: May 16, 2017; Accepted: June 16, 2017; Published: June 23, 2017

Abstract

A 55-year-old male presented with multiple injuries including blunt chest trauma following a road traffic accident. Electrocardiogram showed acute extensive anterior wall myocardial infarction. Echo-cardiogram revealed mildly dilated left ventricle with left ventricular ejection fraction of 25%. Coronary angiogram showed acute left main coronary artery-left anterior descending artery dissection. Due to multiple associated injuries and severe head injury the patient was not amenable for angioplasty, which directed us to perform emergency off-pump coronary artery bypass grafting.

Introduction

Traumatic coronary artery dissection after blunt chest trauma is extremely rare [1]. It is usually associated with multiple organ traumas. Thrombolytic therapy, percutaneous intervention, and coronary artery bypass grafting are the various therapeutic options [2]. We describe a patient with acute coronary artery dissection after blunt chest trauma, which underwent Off-Pump Coronary Artery Bypass Grafting (OPCAB).

Case Report

A 55-year-old male presented with history of alleged road traffic accident (motorcycle versus motorcycle). He had history of loss of consciousness, retrograde amnesia, two episodes of vomiting and bleeding from the left nostril.

On examination, the patient had a Glasgow coma score of E4M6V5 with pupils bilaterally and equally reactive to light. He was hemodynamically stable with a blood pressure of 110/80mmHg and heart rate of 97 beats per minute. Heart sounds were regular, no murmurs. Chest was clear; but air entry was decreased on the left side. Abdomen was soft; no hepatosplenomegaly; non tender; bowel sounds present. No focal neurological deficits.

There was associated diffuse lung contusion; fracture thyroid lamina; fracture ribs including 1st rib; fracture right femur; fracture mandible and fracture left frontal and temporal bone, lateral wall of left orbit and left zygomatic arch.

CT brain (Figure 1) revealed Sub Dural Hemorrhage (SDH) in the left temporo-frontal region, maximum thickness of 11.5mm.