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Atrial fibrillation as a contributing factor in the diagnostic algorithm for coronary subclavian steal syndrome and cardiac tamponade following coronary artery bypass graft surgery: a case study

Luka Perčin ; Department of Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb, Croatia
Blanka Glavaš Konja ; Zagreb University School of Medicine, Zagreb, Croatia
Joško Bulum ; Department of Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb, Croatia
Dražen Perkov ; Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Zagreb, Croatia
Majda Vrkić Kirhmajer ; Zagreb University School of Medicine, Zagreb, Croatia

Puni tekst: engleski pdf 1.333 Kb

str. 283-287

preuzimanja: 89



Coronary subclavian steal syndrome (CSSS) is a complica
tion of coronary artery bypass graft (CABG) surgery in pa
tients with coexistent significant subclavian artery stenosis
(SAS). It is characterized by a retrograde blood flow through
the left internal mammary artery graft from the coronary
to subclavian circulation, leading to myocardial ischemia.
Current screening for CSSS includes bilateral blood pres
sure measurement for the detection of a significant interarm blood pressure difference. However, the commonly
used automated sphygmomanometers have limited accu
racy in patients with atrial fibrillation. Consequently, these
patients are often underdiagnosed. We present a case of a
73-year-old man with a medical history of atrial fibrillation,
peripheral artery disease, and CABG surgery four months
before the current event, who came to the emergency de
partment due to progressive dyspnea. The initial diagnos
tic management showed a large circulatory pericardial effusion, so the patient was admitted to the coronary care
unit and underwent pericardial drainage. In the following
days, due to a sudden high increase in cardiac troponin,
the patient underwent an urgent coronary angiography,
which revealed severe left SAS with functional CABG, indi
cating the occurrence of CSSS. Percutaneous transluminal
angioplasty was then performed with an optimal angio
graphic result. The patient was discharged in good condi
tion with adequate medicament therapy and instructions.
This case report highlights atrial fibrillation as a contribut
ing factor for the diagnosis of CSSS and pericardial tam
ponade after CABG surgery. Furthermore, we suggest a di
agnostic approach that can reduce the incidence of both
these severe complications

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