SummaryBackground: The patent internal thoracic artery graft (ITAG) usually has a diastolic fraction (DF) > 50% of the flow. The functional assessment can be evaluated by the coronary reserve index (CRI).

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ResumoIntrodução: A circulação extracorpórea (CEC) e o manuseio da aorta ascendente (MAA) estão associados a alta incidência de acidente vascular cerebral (AVC) na cirurgia de revascularização do miocárdio (RM) em pacientes idosos. Esta complicação deve-se, sobretudo, ao MAA, por ocasião do pinçamento e despinçamento, quer para isolamento do coração do circuito de CEC, quer para realização das anastomoses dos enxertos na aorta ascendente.Objetivos: Verificar mortalidades imediata e a médio prazo e a ocorrência de AVC no pós-operatório imediato (POI) em pacientes acima de 75 anos submetidos a cirurgia de revascularização do sistema coronariano esquerdo (SCE), sem CEC e sem MAA.Método Análise das mortalidades imediata e a médio prazo e das complicações neurológicas no pós-operatório imediato

A 34-year old, healthy man, reporting very strong, oppressive precordial pain, triggered by exertional exercise (soccer game), radiating to back and left arm, and associated to cold sweating for over 1 hour and with no alleviating factor. The patient denied risk factors for CAD. The patient looked for medical assistance only 2 days after the clinical event. Physical exam showed: BP: 120x 60mmHg; HR: 60b.p.m; Cardiac auscultation: regular rhythm, S4; Pulmonary auscultation: Normal. Electrocardiogram at admission showed: sinusal rhythm with pathological Q waves in lower leads (D2, D3 and aVF) (Fig. 1). Laboratory exams at admission showed: CPK-971 IU/L (normal < 195 IU/L); CK-MB-59.7 IU/L (normal< 25IU/L); troponin-2.15 ng/ml (normal<0.1 ng/ml). Elective coronary angiography identifi ed ulcerated plaque with thrombus adhered to its surface in the initial third of right coronary artery (Fig. 2.1.A) and spontaneous dissection in middle third of left anterior descending (Fig. 2.1.B); Left ventriculography showed: inferior hypokinesia (+++/+4). Atrium Flyer 3,5x16mm stent implantation was carried out in left anterior descending (Fig. 3.1.A) and infusion of IIb/IIIA inhibitor + IV heparin + clopidogrel + aspirin was indicated, with recommendation of a re-study 48 hours after therapeutic regimen. Control coronariography showed dissolution of intracoronary thrombus (Fig. 3.1.B).

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