Acute Mesenteric Ischaemia Following Cardiac Operations

Shi-Min Yuan

《童綜合醫學雜誌》 16卷1期 (2022/06) Pp. 1-7

https://doi.org/10.53106/207135922022061601001

摘要

Acute mesenteric ischaemia (AMI) is an uncommon but sometimes lethal sequel after heart operations. However, no definite diagnostic and therapeutic guidelines have been established so far. It has been reported that AMI occurs on postoperative day six after cardiac operation, with non-occlusive mesenteric ischaemia being the main mechanism leading to AMI. Furthermore, the treatment choices are primarily conservative, including angiography and papaverine infused at 30-60 mg/hour through an angiographic catheter. Others include fluid expansion and antibiotic and anticoagulant treatments. Nevertheless, urgent exploratory laparoscopy or even laparotomy is warranted for patients with peritoneal signs. The surgical principles for treating AMI are bowel resection, embolectomy/thrombectomy and endarterectomy with or without antegrade percutaneous stenting, aiming at restoring blood flow to the superior mesenteric artery. Still, the prognosis is poor, with an overall mortality rate of 71.8%. Therefore, an early suspicion leading to the diagnosis of postoperative AMI is crucial for improving patients' outcomes.

關鍵字

Cardiac surgical procedures ； coronary artery bypass ； mesenteric ischaemia