Amyloid of Heart and Lungs in a Patient with Low Output Syndrome after Coronary Artery Bypass Grafting

Abstract

A 70-year-old patient with two-vessel disease and moderately reduced left ventricular function after a recent myocardial infarction was admitted for a routine coronary artery bypass grafting (CABG) procedure. During anesthetic induction, he became unstable and cardiopulmonary bypass had to be instituted urgently. Despite good bypass flows, the patient died in myocardial failure shortly after surgery. At autopsy, besides severe atherosclerotic coronary artery disease, cardiac and pulmonary amyloidosis were found.

Plasma ropivacaine concentration after TAP block in a patient with cardiac and renal failure

“… 5 There are several reports describing the occurrence of fatal perioperative myocardial infarction in patients with cardiac amyloidosis. 6 , 7 Cardiotonic agents are not useful because diastolic dysfunction, which was also seen in our patient, is the predominant feature of cardiac amyloidosis. 5 We, thus, presumed that general anesthesia and central neuraxial blockade might cause severe hypotension in this patient due to sympathetic blockade, possibly increasing the risk of myocardial ischemia.…”

Amyloidosis and Cardiac Surgery

“…When cardiac hypertrophy is not strikingly present diastolic dysfunction can be easily overlooked or not taken into account. Fatal outcome of coronary artery bypass grafting in misdiagnosed patients with cardiac amyloidosis has been reported by several authors (Massoudy, Szabo et al 2003;Massias, Vyssoulis et al 2006;Zacek, Medilek et al 2007). In our institutional records (unpublished data) there were four fatal cases of undiagnosed cardiac amyloidosis indicated for coronary surgery (3x) or mitral and tricuspid valve repair (1x) (Fig.…”

Cardiac amyloidosis in non‐transplant cardiac surgery

“…It is therefore possible for surgical revascularisation to be undertaken without recognition of CA and the excessive risks it carries with it. On review of the literature, case reports of co‐existing CA and surgical revascularisation report universally poor postoperative outcomes 51–55 . In five cases, a postoperative irreversible low cardiac output state developed.…”