Coronary Artery Bypass Grafting for Refractory Ventricular fibrillation after the Release of the Aortic Cross-Clamp in Patients Undergoing Aortic Valve Replacement: A Case Report

Authors

  • Xiao-Jie Yu Department of Clinical Laboratory, The First Hospital of Jilin University, 130021 Changchun, Jilin, China
  • Da-Shi Ma Department of Cardiac Surgery, The First Hospital of Jilin University, 130021 Changchun, Jilin, China
  • Mu-Shui Qiu Department of Cardiac Surgery, The First Hospital of Jilin University, 130021 Changchun, Jilin, China

DOI:

https://doi.org/10.59958/hsf.6713

Keywords:

ventricular fibrillation, aortic cross-clamp release, coronary artery bypass grafting, aortic valve replacement, refractory arrhythmias

Abstract

Background: Ventricular fibrillation (VF) is a known complication after the release of the aortic cross-clamp (ACC) during cardiopulmonary bypass (CPB) surgery. Various factors contribute to persistent refractory VF, making its management challenging. This case report describes the successful treatment of postoperative refractory VF by coronary artery bypass grafting (CABG) in a patient undergoing aortic valve replacement (AVR) with ACC release. Case Presentation: A 52-year-old woman with a history of hypertension and ischemic cerebral infarction presented with symptoms of chest tightness, dyspnoea and palpitations. She underwent a modified maze procedure of radiofrequency ablation, mitral repair, left atrial appendage closure and mechanical AVR under a CPB procedure. Following the ACC release, the patient experienced recurrent VF that was unresponsive to standard interventions such as lidocaine, amiodarone and direct current shocks. The suspicion of right coronary artery (RCA) insufficiency led to the decision to perform CABG using the great saphenous vein. After the CABG procedure, the patient's heart rhythm gradually returned to sinus rhythm, and she had an uneventful recovery. Discussion and Conclusions: Refractory VF after the ACC release can pose diagnostic and treatment challenges. In this case, RCA insufficiency was suspected as the cause of refractory VF. The absence of blood flow in the proximal RCA and the presence of distal blood return during cardiac surface exploration supported this suspicion. Coronary artery bypass grafting using the great saphenous vein successfully restored normal sinus rhythm, confirming the diagnosis. This case emphasises the importance of considering coronary artery stenosis or occlusion as a potential cause of refractory VF after the ACC release during CPB, with CABG serving as a viable alternative treatment.

References

Mita N, Kagaya S, Miyoshi S, Kuroda M. Prophylactic Effect of Amiodarone Infusion on Reperfusion Ventricular Fibrillation After Release of Aortic Cross-Clamp in Patients with Left Ventricular Hypertrophy Undergoing Aortic Valve Replacement: ARandomized Controlled Trial. Journal of Cardiothoracic and Vascular Anesthesia. 2019; 33: 1205–1213.

Morita Y, Mizuno J, Yoshimura T, Morita S. Efficacy of amiodarone on refractory ventricular fibrillation resistant to lidocaine and cardioversion during weaning from cardiopulmonary bypass in aortic valve replacement for severe aortic stenosis with left ventricular hypertrophy. Journal of Anesthesia. 2010; 24: 761–764.

Landow L, Wilson J, Heard SO, Townsend P, VanderSalm TJ, Okike ON, et al. Free and total lidocaine levels in cardiac surgical patients. Journal of Cardiothoracic Anesthesia. 1990; 4: 340–347.

Riva E, Hearse DJ. Anti-arrhythmic effects of amiodarone and desethylamiodarone on malignant ventricular arrhythmias arising as a consequence of ischaemia and reperfusion in the anaesthetised rat. Cardiovascular Research. 1989; 23: 331–339.

Kodaka M, Mori T, Ichikawa J, Ando K, Komori M. Refractory ventricular arrhythmias during aortic valve replacement and cardiac artery bypass requiring 16 attempts of electrical cardioversion: a case report. JA Clinical Reports. 2020; 6: 60.

Bouchard S, Jacquemet V, Vinet A. Automaticity in acute ischemia: bifurcation analysis of a human ventricular model. Physical Review. E, Statistical, Nonlinear, and Soft Matter Physics. 2011; 83: 011911.

Published

2024-02-01

How to Cite

Yu, X.-J., Ma, D.-S., & Qiu, M.-S. (2024). Coronary Artery Bypass Grafting for Refractory Ventricular fibrillation after the Release of the Aortic Cross-Clamp in Patients Undergoing Aortic Valve Replacement: A Case Report. The Heart Surgery Forum, 27(2), E085–E088. https://doi.org/10.59958/hsf.6713

Issue

Section

Case Report