Following the aortic cross-clamping, diastolic cardiac arrest was maintained via antegrade cardioplegia
administration from the aortic root.
In most cases, it has been attributed to the use of ostial cannulation for antegrade cardioplegia
during surgery, which can cause a mechanical injury to the coronary ostium resulting in hyperplastic reaction and stenosis [5, 7, 8].
was given and cold saline poured in pericardium.
Myocardial protection by cold antegrade cardioplegia
for Grafting (SVG to LAD and PDA of RCA).
Coronary artery bypass surgery on a beating heart precludes multiple of the previously mentioned risk factors for the development of postoperative neurological complications, that is, aortic cannulation, aortic cross-clamping, and antegrade cardioplegia
, as well as the possible cerebral inflammatory response to CPB [27, 28].
Given the severe aortic insufficiency, retrograde was preferred over antegrade cardioplegia
. Once CPB was established, retrograde cardioplegia administration was attempted but there was difficulty achieving pressurization of the coronary sinus.
The ascending aorta was cross-clamped, and diastolic cardiac arrest was induced with antegrade cardioplegia
. A nasopharyngeal temperature >34[degrees]C and a perfusion pressure >80 mm Hg were maintained during CPB.
The patients were randomised into 2 groups; Group I had patients in whom multiperfusion set was used for cardioplegia and continuous warm blood perfusion through vein grafts during proximal ends anastomosis, and Group II had patients in whom routine aortic root antegrade cardioplegia
was used with no warm blood perfusion during proximal anastomosis of vein grafts.
Following cross clamp, diastolic cardiac arrest was induced by administration of antegrade cardioplegia
and myocardium was protected by repeating this every 20-25 minutes.
with hyperkalemic cold blood administration from aorta root was induced with a dose of 10 ml/kg at the beginning of ischemia and of 5 ml/kg at the maintenance with intervals of 20 minutes.
In OPBCABG, cross clamping of the aorta was eliminated, but in the conventional method, introducing global ischemia and protection of the heart by retrograde and antegrade cardioplegia
is a routine manner.
It has previously been reported as a complication originating from crossclamp injury3 or from intimal tears at the suture line of a CABG1 or from the site of cannulation.6 In thepresent case, the intimal tear was identified in the anterior of the ascending aorta, which was compatible with the site of the suture line of the SVG or the site of antegrade cardioplegia
infusion but intraoperative findings were not conclusive to clarify the etiology of the dissection.