Urgent Coronary Artery Bypass Graft Surgery in a Patient with Post-Cardiac Injury Syndrome: A Very Rare Case Report

Coronary artery bypass surgery in a patient with post-cardiac injury syndrome (PCIS or sever pericarditis following myocardial infarction) is very rare and extremely difficult. The risk of incomplete and unsuccessful revascularization and cardiac damage is high. Incomplete surgery can lead to increased mortality and postoperative complications. A case of emergency coronary artery bypass surgery in a patient with post-cardiac injury syndrome is reported.

Case Report: 

A 64-years-old man was admitted to Seyed-al-Shohada Heart Center of Urmia with chest pain and exertional dyspnea from two weeks before. His comorbidities included diabetes mellitus (type II), hypertension, smoking and obesity. The electrocardiogram showed atrial fibrillation with rapid ventricular response.  Echocardiographic study demonstrated 50% ejection fraction and mild to moderate pericardial effusion.  In laboratory tests, low hemoglobin and high serum creatinine were seen. Coronary angiography showed 50% distal stenosis of left main coronary artery as well as involvement of three heart vessels. During urgent coronary artery bypass surgery, we found severe and diffuse inflammation of cardiac surface and thickening of the pericardium. In the probable coronary artery route, limited release of visceral pericardial adhesions was performed. Coronary artery bypass graft surgery was performed. Weaning from cardiopulmonary bypass (CPB) was done with normal sinus rhythm and low dose inotrope. The only postoperative complication of the patient was exacerbation of preoperative renal failure. So, hemodialysis was performed once on the second postoperative day. The patient was discharged from the hospital on the 8th postoperative day. Follow up examination on the 12th months following operation revealed no clinical problems and echocardiographic study showed no pericardial effusion.

Based on the results of our report, limited and carefully release of inflammatory epicardial adhesions should be done to find the target coronary arteries and to avoid heart failure.