Acute pleuropulmonary complications detected by computed tomography following myocardial revascularization

Abstract

INTRODUCTION:Pleuropulmonary changes are common following coronary artery bypass grafting surgery performed with a saphenous vein graft, with or without an internal mammary artery. The presence of atelectasis or pleural effusions reflects the thoracic trauma.PURPOSE: To define the postoperative incidence of changes in the lung and in the pleural space and to evaluate the influence of the trauma.METHODS: Thirty patients underwent elective coronary artery bypass grafting surgery (8 saphenous vein grafts and 22 saphenous vein grafts and internal mammary artery grafts with pleurotomy). Chest tubes in the left pleural space were used in all internal mammary artery patients. On the second (day 2) and seventh (day 7) postoperative day, patients underwent a computed tomography, and pleural effusions were rated as follows: grade 0 = no fluid to grade 4 = fluid in more than 75% of the hemithorax. Atelectasis was rated as follows: laminar = 1, segmental = 3, and lobar = 10 points.RESULTS: All patients had pleural effusion or atelectasis. Between day 2 and day 7, the number of patients with effusions or atelectasis on the right side decreased (P < 0.05). The incidence of effusions on day 2 in the saphenous vein graft group (87.5%) was higher (P < 0.05) than in the internal mammary artery group (52.3%). The incidence of atelectasis in the lower right lobe decreased (P < 0.05) from 86.7% (day 2) to 26.7% (day 7). The degree of atelectasis in both sides did not differ on day 2 (P = 0.42) but did on day 7 (P < 0.0001). There was a decrease in the atelectasis from day 2 to day 7 on the right side (P < 0.001), but not on the left (P = 0.21). On day 2 there was a relationship between atelectasis and effusion on the right (P = 0.04), but not on the left (P = 0.113).CONCLUSION: The present series demonstrates that there is a high incidence of both minimal pleural effusion and atelectasis after coronary artery bypass grafting surgery, which drops on the right side from day 2 to day 7 post surgery. Factors that contribute to the persistence of changes on the left side include the thoracic trauma and the presence of chest tubes and pericardial effusion.

Effect of Pleurotomy on Blood Loss During Coronary Artery Bypass Grafting

“…Regarding the effect of IMA harvesting technique, bilateral IMA harvesting or pleural opening on respiratory function are controversial. Some authors noted an increased incidence of pulmonary complications in patients with open pleural IMA harvesting technique 5‐18 . We have also seen extremely high incidence of left pleural effusion on day 3 (96.2%) in patients with open pleural group.…”

“…Some authors noted an increased incidence of pulmonary complications in patients with open pleural IMA harvesting technique. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] We have also seen extremely high incidence of left pleural effusion on day 3 (96.2%) in patients with open pleural group. Incidence of left pleural effusion was significantly low in patients with preserved pleural integrity, both on day 1 and day 3 (37.6% and 60.8%, respectively).…”

Fisioterapia respiratória na disfunção pulmonar pós-cirurgia cardíaca

“…It was found at a rate of 32% and 43.9% on the 2 nd and 3 rd postoperative day (POD), respectively [20]. Westerdahl et al [21] found it in 63% of patients on the 4 th POD, data similar to the study of Vargas et al [38], on which the authors used TCT as preliminary tool.…”

Influência da força muscular respiratória na evolução de pacientes com insuficiência cardíaca após cirurgia cardíaca

“…Vargas et al [24] studied by computed tomography (CT) the presence of atelectasis and pleural effusion in the postoperative period of CABG and found that all patients on the 2nd POD presented some degree of atelectasis or pleural effusion. However, they also state that the vast majority of the pleural effusions observed by CT were minimal and the atelectasis were laminar, or that is, most of these findings can not be observed on radiographs.…”