Transient Bilateral Cortical Visual Loss after Coronary Artery Bypass Grafting in a Normotensive Risk-Free Patient

Authors

  • Jamshid Bagheri
  • Mohammad-Hossein Mandegar
  • Mahmood-Reza Sarzaeem
  • Sam Chitsaz

DOI:

https://doi.org/10.1532/HSF98.20081014

Abstract

Background: Postoperative blindness has been mentioned as a rare complication of heart surgery. The majority of reported cases are caused by retinal artery occlusion or ischemic optic neuropathy. We report a case of transient visual loss due to cortical ischemia after coronary artery bypass grafting (CABG).

Case Report: A 52-year-old nondiabetic man developed complete bilateral visual loss immediately after CABG. He had been normotensive throughout the operation. An ophthalmologic exam detected no causative ocular damage. The results of a Doppler study of the carotid, vertebral, and ophthalmic arteries were completely normal, and an echocardiography examination showed no left ventricular clot. Magnetic resonance imaging of the brain, however, showed several ischemic plaques in watershed areas and a small subacute infarct in the occipital lobe. Recovery began on postoperative day 4, and the patient's vision was restored in 6 months.

Conclusion: Although most cases of visual loss after open heart surgery have been caused by injuries to the peripheral optic system, cortical blindness may occur following open heart surgery in the absence of any preexisting risk factor. Fortunately, the course of recovery is promising one, as it was for our patient.

References

McKhann GM, Grega MA, Borowicz LMJ, Baumgartner WA, Selnes OA. 2006. Stroke and encephalopathy after cardiac surgery: an update. Stroke 37:562-71.nMoster ML. 1998. Visual loss after coronary artery bypass surgery. Surv Ophthalmol 42:453-7.nNewman SP, Harrison MJG. 2002. Coronary-artery bypass surgery and the brain: persisting concerns. Lancet Neurol 1:119-25.nNuttal G, Garrity J, Dearani J. 2001. Risk factors for ischemic optic neuropathy after cardiopulmonary bypass: a matched case/control study. Anesth Analg 93:1410-6.nRoth S, Thisted RA, Erickson JP, Black S, Schreider BD. 1996. Eye injuries after nonocular surgery. A study of 60,965 anesthetics from 1988 to 1992. Anesthesiology 85:1020-7.nRoth S, Gillesberg I. 1999. Injuries to the visual system and other sense organs. In: Benumof JL, Saidman LJ, eds.: Anesthesia and Perioperative Complications, 2nd ed. St Louis, Mo: CV Mosby. pp 377-408.nSha'aban RI, Asfour WM. 2000. Visual loss after coronary artery bypass surgery. Saudi Med J 21:90-2.nTaugher PJ. 1976. Visual loss after cardiopulmonary bypass. Am J Ophthalmol 81:280-8.nWarner MA. 2006. Postoperative visual loss: experts, data, and practice. Anesthesiology 105:641-2.nWilliams EL. 2002. Postoperative blindness. Anesthesiolog Clin North Am 20:605-22.n

Published

2008-09-05

How to Cite

Bagheri, J., Mandegar, M.-H., Sarzaeem, M.-R., & Chitsaz, S. (2008). Transient Bilateral Cortical Visual Loss after Coronary Artery Bypass Grafting in a Normotensive Risk-Free Patient. The Heart Surgery Forum, 11(4), E248-E251. https://doi.org/10.1532/HSF98.20081014

Issue

Section

Articles