No abstract

Summary: Constrictive pencarditis after coronary artery bypass grafting (CABG) is rare and can present as unexplained dyspnea. We report five consecutive cases of post-CABG constrictive pericarditis seen within a period of I7 months at our institution. All patients presented with heart failure ofunknown etiology within a period of 8-84 months after surgery. During the initial post-CABG period, two patients had developed postcardiotomy syndrome that was successfully treated with steroids. They were all assessed noninvasively and invasively. In all patients, the diagnosis of constriction was initially suspected clinically ( symptoms, high jugular venous pressure with deep "X" and "Y" descents, pericardial knock). Echocardiography showed transmitral flow typical of constriction in all patients and hepatic venous flow in two. Two patients showed rapid left ventricular relaxation. In all patient s, hemodynamic assessment showed diastolic equalization of pressures in all chambers, "W' shape waveform in right atrial pressure, and "dip and plateau" configuration in right and left ventricular pressure waveforms. Diagnosis was confirmed surgically in four patients who were subjected to pericardiectomy-pericardial stripping (three survived. one died). One patient rehsed surgery. We conclude that constrictive pericarditis, although rare, should be suspected in every case of unexplained dyspnea post CABG. It can appear early or late after surgery, and clinical examination plays an important role in its early recognition. It requires a full noninvasive and invasive assessment in case of clinical suspicion.

An under tension graft to the right coronary artery may result in graft spasm, hypoperfusion and myocardial infarction. We suggest plication of the right atrium in order to confront the under tension graft (either arterial or venous), if tension is due to a shorter (up to 2 cm) graft than one needed. We present this technique applied to 10 of our patients. The radial artery was the under tension graft in two cases and a saphenous vein in eight. Perioperative and postoperative arrhythmias, myocardial infarction, hemorrhage and jugular or hepatic congestion were not observed. Central vein pressure remained normal. Tricuspid valve--estimated by postoperative echo--was undisturbed. Plication of the right atrium in case of an under tension graft is a quick, simple and safe technique.

We present a less traumatic surgical technique for harvesting the radial artery as a coronary artery bypass graft that does not require any special equipment or skills. We prospectively randomized 40 patients undergoing coronary artery bypass grafting with the radial artery into two groups on the basis of harvest techniques: tunneling excision and conventional open method. The less-invasive tunneling technique is safe, easily applicable, and preferred by patients because of the superior cosmetic result.