초록접수 현황
| 16F-196 | 포스터 발표 |
Management of Left Vertricular Thrombus Detected in the Perioperative Period of Coronary Artery Bypass Grafting
Hyung Tae Sim, Hyoung Woo Chang, Jae Suk Yoo, Dong Jin Kim, Kwang Ree Cho
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Korea
Background : Left ventricular (LV) thrombus is occasionally encountered when performing coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICMP). Surgical removal of LV thrombus is challenging and perioperative management of LV thrombus is not well established. We experienced seven cases of off-pump CABG in LV thrombus without surgical removal.
Methods : All seven patients underwent off-pump CABG using bilateral internal thoracic arteries. Median age was 63.5 years (range 50.8 – 73.2). All patients showed severe left ventricular dysfunction (Ejection fraction <30%) on preoperative echocardiography. LV thrombus was detected by echocardiography or cardiac MRI preoperatively (n=5) or postoperatively (n=2). Medical treatment of LV thorombus was initiated by combined administration of warfarin and aspirin. When LV thrombus was disappeared on follow up echocardiography, medications were changed to dual antiplatelet therapy (aspirin + P2Y12 receptor inhibitor).
Results : There were no early mortality and thromboembolic complications. Mean follow-up duration was 8.5 ± 6.5 months. During follow up, one patient died of metastatic cancer unrelated to cardiac problem. LV thrombus was disappeared completely on follow up echocardiography in the rest of six patients: Three cases were disappeared at immediate postoperative period and 3 cases were disappeared at 3 months after the operation. There were no thromboembolic complications related to LV thrombus during follow up period.
Conclusion : LV thrombus was disappeared completely by medical therapy alone. Patients with LV thrombus could undergo off-pump CABG safely without further removal of the thrombus.
Methods : All seven patients underwent off-pump CABG using bilateral internal thoracic arteries. Median age was 63.5 years (range 50.8 – 73.2). All patients showed severe left ventricular dysfunction (Ejection fraction <30%) on preoperative echocardiography. LV thrombus was detected by echocardiography or cardiac MRI preoperatively (n=5) or postoperatively (n=2). Medical treatment of LV thorombus was initiated by combined administration of warfarin and aspirin. When LV thrombus was disappeared on follow up echocardiography, medications were changed to dual antiplatelet therapy (aspirin + P2Y12 receptor inhibitor).
Results : There were no early mortality and thromboembolic complications. Mean follow-up duration was 8.5 ± 6.5 months. During follow up, one patient died of metastatic cancer unrelated to cardiac problem. LV thrombus was disappeared completely on follow up echocardiography in the rest of six patients: Three cases were disappeared at immediate postoperative period and 3 cases were disappeared at 3 months after the operation. There were no thromboembolic complications related to LV thrombus during follow up period.
Conclusion : LV thrombus was disappeared completely by medical therapy alone. Patients with LV thrombus could undergo off-pump CABG safely without further removal of the thrombus.
책임저자: Kwang Ree Cho
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Korea
발표자: Hyung Tae Sim, E-mail : artistsim@naver.com