Sudden Thrombosis in Coronary Artery Bypass Grafting Surgery

2835 Correspondence To the Editor: A 47‑year‑old male patient was admitted because of chest discomfort for 2 weeks. He had no obvious incentive precordial discomfort 2 weeks ago, accompanied by palpitation. He immediately went to the town hospital. Electrocardiogram (ECG) showed myocardial infarction. Coronary angiography showed coronary artery disease accompanied by a ventricular aneurysm. The patient was transferred to Beijing Anzhen Hospital. ECG showed sinus rhythm, heart axis deviation + 111°, anterior septal, anterior lateral, anterior myocardial infarction, and complete right bundle branch block. Chest X‑ray showed no obvious abnormalities in heart and lung. Echocardiography showed abnormal motion of segmental ventricular wall; formation of a ventricular aneurysm in apex area of the heart, the diameter of the ventricular aneurysm was 2 cm, the diastolic function of left ventricular was reduced. Coronary angiography showed left anterior descending artery filling slowly and its intima was not smooth; the stenosis rate was 90%. The stenosis rate of the circumflex artery was 90% [Figure 1a and b]. He was diagnosed with acute anterior myocardial infarction, left ventricular aneurysm, and hypertension. The patient received treatment of dilation of a coronary artery, anticoagulation, nourishing myocardium, and other symptomatic and supportive treatment. He underwent off‑pump coronary artery bypass surgery with median incision of the sternum. Take the left internal mammary artery and the right saphenous vein in reserve. Activating clotting time (ACT) value was 391 s after intravenous injection of 75 mg heparin. Left internal mammary artery ‑ left anterior descending artery; aorta ‑ saphenous vein ‑ obtuse marginal branch vascular anastomosis were performed using external fixator. Anastomotic stoma was unobstructed and nonhemorrhage. Flow meter displayed satisfactory flow in grafts. Heparin was neutralized followed by routine chest shut surgery. The patient broke out in the sudden reduction of blood pressure and ventricular fibrillation. Defibrillation (200 Ws) and emergency chest compressions were performed followed by exploratory thoracotomy surgery. Intra‑aortic balloon counterpulsation (IABP) was used as an assistive device. Extracorporeal circulation was established. Heparin (250 mg) was intravenously injected. ACT value after heparin injection was 486 s, intraoperative ACT value was 610 s. Flow meter displayed no flow in grafts. A redo coronary artery bypass grafting surgery was performed. Thrombosis was found in the left internal mammary artery distal anastomosis and the left anterior descending artery, saphenous vein proximal and distal anastomosis, and the circumflex artery. The thrombus in anastomosis and grafts was carefully removed and the proximal and …