[HSF] Rhabdomyolysis following CABG
Ben Bidstrup
benjamin.bidstrup at bigpond.com
Fri Feb 1 10:36:07 EST 2008
Blauth presented a paper when he was a fellow at the Cleveland Clinic
in the 90's. At autopsy they looked at the frequency and distribution
of emboli after OHS.
PMID- 1597974
OWN - NLM
STAT- MEDLINE
DA - 19920706
DCOM- 19920706
LR - 20061115
PUBM- Print
IS - 0022-5223 (Print)
VI - 103
IP - 6
DP - 1992 Jun
TI - Atheroembolism from the ascending aorta. An emerging problem in
cardiac surgery.
PG - 1104-11; discussion 1111-2
AB - As the ages of patients undergoing cardiac operations have
increased, noncardiac
causes of death have increased. To identify these causes of
death, we analyzed
the autopsy findings in 221 patients undergoing myocardial
revascularization or
valve operations between 1982 and 1989. Mean age was 65.6 +/-
9.5 years and the
range was from 32 to 94 years; 130 patients (58.8%) were male.
Autopsies were
complete in 129 patients (58.4%) and limited to the chest and
abdomen in the
remainder. Embolic disease was identified in 69 patients
(31.2%). Atheroemboli or
abnormalities consistent with atheroemboli were identified in 48 patients
(21.7%). Fourteen patients had thromboembolism and 7 had disseminated
intravascular coagulation. The prevalence of atheroembolic
disease increased
dramatically from 4.5% in 1982 to 48.3% in 1989 (p = 0.001).
Atheroembolic
disease was found in the brain in 16.3% of patients, spleen in
10.9%, kidney in
10.4%, and pancreas in 6.8%. Thirty (62.5%) of the 48 patients
had multiple
atheroembolic sites. Atheroemboli were more common in patients undergoing
coronary artery procedures (43/165; 26.1%) than in those undergoing valve
procedures (5/56; 8.9%) (p = 0.008). There was a high
correlation of atheroemboli
with severe atherosclerosis of the ascending aorta.
Atheroembolic events occurred
in 46 of 123 patients (37.4%) with severe disease of the
ascending aorta but in
only 2 of 98 patients (2%) without significant ascending aortic
disease (p less
than 0.0001). Forty-six of 48 patients (95.8%) who had evidence
of atheroemboli
had severe atherosclerosis of the ascending aorta. There was a
direct correlation
between age, severe atherosclerosis of the ascending aorta, and
atheroemboli.
Incremental risk factors for atheroembolic are peripheral
vascular disease and
severe atherosclerosis of the ascending aorta.
AD - Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation,
OH 44195-5066.
FAU - Blauth, C I
AU - Blauth CI
FAU - Cosgrove, D M
AU - Cosgrove DM
FAU - Webb, B W
AU - Webb BW
FAU - Ratliff, N B
AU - Ratliff NB
FAU - Boylan, M
AU - Boylan M
FAU - Piedmonte, M R
AU - Piedmonte MR
FAU - Lytle, B W
AU - Lytle BW
FAU - Loop, F D
AU - Loop FD
LA - eng
PT - Comparative Study
PT - Journal Article
PL - UNITED STATES
TA - J Thorac Cardiovasc Surg
JT - The Journal of thoracic and cardiovascular surgery
JID - 0376343
SB - AIM
SB - IM
MH - Age Factors
MH - Aorta/pathology
MH - Aortic Diseases/*complications/epidemiology/pathology
MH - Arteriosclerosis/*complications/epidemiology/pathology
MH - Chi-Square Distribution
MH - Coronary Disease/complications/surgery
MH - Disseminated Intravascular Coagulation/epidemiology/etiology
MH - Embolism/epidemiology/*etiology/pathology
MH - Heart Valve Diseases/complications/surgery
MH - Humans
MH - Incidence
MH - Logistic Models
MH - Ohio/epidemiology
MH - Postoperative Complications/epidemiology/*etiology/pathology
MH - Prevalence
MH - Probability
MH - Risk Factors
MH - Sex Factors
EDAT- 1992/06/01
MHDA- 1992/06/01 00:01
PST - ppublish
SO - J Thorac Cardiovasc Surg. 1992 Jun;103(6):1104-11; discussion 1111-2.
>Ahmed
>
>I have just come back from one of my not infrequent visits to the
>autopsy suite to study one of my VAD catastophes and suspect your
>patient may have what we found in mine. I would suggest you consider
>cholesterol crystal embolization from the IABP as the cause of your
>findings in this patient. It is well described in the setting of
>IABP use and would explain your renal failure and skin findings.
>
>I had a patient I placed an LVAD in last week who developed severe
>lactic acidosis within 24 hours of surgery. An IABP had been placed
>the day before surgery. Colonoscopy showed what had appearance of
>full thickness rectal necrosis (rectal necrosis is rare and
>signifies some pronounced low flow state or watershed embolization).
>At autopsy there were infarcts in the liver, spleen, kidneys and
>gut. The descending aorta showed multiple soft plaques with a 2cm
>disruption in one plaque. Looking at the aorta it is not difficult
>to imagine how having it rammed by a balloon 90 times a minute for 2
>days could not have been a good thing. The pathologist tells me that
>they will almost certainly see embolized cholesterol crystals when
>they look at the tissues.
>
>Ani
>
>
>
>> Date: Thu, 31 Jan 2008 23:05:35 +0000> From:
>>drdharris at yahoo.co.uk> Subject: RE: [HSF] Rhabdomyolysis following
>>CABG> To: OpenHeart-L at lists.hsforum.com> CC: > > Next time try
>>anaortic OPCAB with BIMA?> Dave> > --- alsadd <alsadd at ksu.edu.sa>
>>wrote:> > > I will try Nasser > > > > -----Original Message-----> >
>>From: openheart-l-bounces at lists.hsforum.com> >
>>[mailto:openheart-l-bounces at lists.hsforum.com] On> > Behalf Of
>>Nasser F.> > Abou'Seada> > Sent: Wednesday, January 30, 2008 7:41
>>AM> > To: OpenHeart-L at lists.hsforum.com> > Subject: Re: [HSF]
>>Rhabdomyolysis following CABG> > > > Could you possibly post the CT
>>/ MRI scans ?> > NFA> > On Jan 30, 2008 1:19 PM, alsadd
>><alsadd at ksu.edu.sa>> > wrote:> > > > > Dear Forum
>>Members:> > >> > >> > >> > >> > >> > > While I was out of town one
>>of our surgeons> > operated a 69 years old man> > > for> > > a 3
>>vessel disease. The patient had bilateral> > carotid stenosis the
>>right> > > 70%> > > and the left 80% he had no symptoms because of
>>the> > vascular surgeon> > > elected> > > to do nothing. At surgery
>>the patient had LIMA to> > LAD, SVG to Diagonal and> > > OM1. After
>>protamine ST segment changes and drop> > in BP. They
>>re-haprinized> > > went back to for a short time elected not to> >
>>reverse heparin the second> > > time> > > and put an
>>IABP.> > >> > > The patient remained stable post op and was> >
>>extubated the following> > > morning.> > > IABP removed. The
>>evening of that day became> > confused and combative ABG> > >
>>were> > > acceptable had to be re intubated over night. It> > was
>>noticed that his CPK> > > level kept on rising initially to 7000
>>and later> > to more than 10000 units.> > > He was put on PRISMA
>>for renal failure in spite of> > this his K went up and> > > was
>>controlled but with difficulty. The following> > morning he
>>developed> > > epidermolysis and blisters of the lower> >
>>extremities skin no compartment> > > was> > > found on assessment
>>both the femoral veins and> > arteries were patent by> > > duplex
>>assessment. He was seen by neurology CT> > scan and MRI were
>>normal.> > > Abdominal CT was normal. He was assessed by> > various
>>services and the> > > differential diagnoses were narrowed to> >
>>rhabdomyolysis. Any thoughts from> > > members would be greatly
>>appreciated> > >> > >> > >> > >> > >> > > Ahmed> > >> > >> > >> > >
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>>-----------------------------------------> > > > > Dr. David G.
>>Harris, FCS, MMED,> Cardiothoracic Surgeon > Suite 207 > Kuils
>>River Private Hospital, > PO Box 1200, Kuils River, 7579, Cape
>>Town, South Africa. > Tel +27-21-9006411 > Fax +27-21-9006412
>>Mobile +27-83-3309587>
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--
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon
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