Survival after acute and complete occlusion of left main stem

Abstract

A 73-year-old man presented with chest pain, elevated troponin levels, and electrocardiographic signs of acute anterior myocardial infarction. Coronary angiography revealed total occlusion of the left main stem (Figure 1AGo) with moderate collateralization from the right coronary artery (Figure 1BGo). An intraaortic balloon pump was inserted prior to induction of anesthesia for emergency coronary bypass grafting. At this point, hemodynamic compromise occurred, and simultaneous induction of anesthesia and mechanical resuscitation were required. After a median sternotomy, internal massage, and institution of cardiopulmonary bypass, beating-heart double-vessel coronary artery bypass was performed. Extracorporeal membrane oxygenation was used as a bridge to recovery. Early postoperative transesophageal echocardiography revealed massive cardiac edema (Figure 1CGo). The patient was successfully weaned from membrane oxygenation 2 days later, and made a good recovery.