ABSTRACT
Isolated reversal of flow in the vertebral artery is a rare phenomenon occurring in the general population and is due to intrinsic anatomical defects. The most common cause is subclavian stenosis; however, reversal of flow in the vertebral artery can occur regardless of any detection of anatomic deterioration. In this series, we report three asymptomatic cases where the extracranial Doppler scan preceding off-pump coronary arterial bypass grafting showed isolated reversal of flow in the vertebral artery. No signs of subclavian stenosis or steal syndrome were elicited. However, all patients subsequently suffered from a posterior circulation stroke following off-pump coronary arterial bypass grafting but recovered fully with medical management. We conclude that a detailed pre-operative neurological investigation can mitigate this risk and improve neurological outcomes following off-pump coronary arterial bypass grafting.
Subject(s)
Coronary Artery Bypass, Off-Pump , Subclavian Steal Syndrome , Constriction, Pathologic/complications , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass, Off-Pump/adverse effects , Humans , Subclavian Steal Syndrome/etiology , Treatment Outcome , Vertebral Artery/diagnostic imaging , Vertebral Artery/surgeryABSTRACT
Primary spindle cell sarcoma of the heart is a rare malignant tumor of the heart. A 65-year-old woman was admitted under our care with complaints of shortness of breath. Echocardiogram showed pedunculated mass in the left atrium. Cardiac magnetic resonance imaging done elsewhere had confirmed a left atrial tumor. No further investigations were considered with a diagnosis of left atrial myxoma. She underwent total excision of the tumor: mitral valve involvement necessitated a repair all of which was done under cardiopulmonary bypass. Histopathology showed a primary spindle cell sarcoma. In view of histology, chemotherapy was planned and initiated. A month after surgery, she presented again with a recurrence.
