%0 Journal Article %T Perioperative Avulsion of a Left Internal Mammary Artery Graft in a Patient with Syphilis %A Vasily I. Kaleda %A Sergei A. Belash %A Alexei V. Barsuk %A Kirill O. Barbuhatti %J Surgery Research and Practice %D 2014 %R 10.1155/2014/574346 %X Avulsion of a graft after coronary artery bypass grafting surgery is a rare but very serious complication which leads to massive bleeding and possible life-threatening cardiac tamponade. In this paper we report a very rare case of a left internal mammary artery graft avulsion on the day of surgery in a patient with syphilis. 1. Introduction Avulsion of a graft after coronary artery bypass grafting (CABG) surgery is a rare but very serious complication which leads to massive bleeding and possible life-threatening cardiac tamponade. It was reported to occur after minimally invasive direct coronary artery bypass (MIDCAB) surgery due to a graft tension and after conventional CABG due to mediastinitis. In this paper we report a very rare case of a left internal mammary artery (LIMA) graft avulsion on the day of CABG surgery in a patient with syphilis. 2. Case Report A 54-year-old male patient presented with 3rd CCS class angina pectoris. Risk factors of coronary artery disease included class I obesity, hypertension, hyperlipidemia, and smoking. Transthoracic echocardiography showed normal size of the ascending aorta with a slight thickening of its wall, normal aortic valve function without regurgitation, and slightly decreasedleft ventricular ejection fraction with local hypokinesia. Pulmonary examination revealed no evidence of chronic obstructive pulmonary disease or marked emphysema. Coronary angiography showed multivessel lesions including proximal left anterior descending artery (LAD) stenosis and occlusion of left circumflex and posterior descending (PDA) arteries. There was no evidence of any arteritis or connective tissue disorder. The patient denied any history of sexually transmitted infection, but preoperative screening for syphilis with rapid plasma reagin (RPR) test was positive (this test is a part of standard examination before surgery in Russia). It was then confirmed with enzyme immunoassay (EIA) test, Treponema pallidum passive particle agglutination assay (TPPA) test, and fluorescent treponemal antibody absorption (FTA-ABS) test. The skin and visible mucous membranes were free from any sign of syphilis. The patient was suspected to have latent syphilis and was offered surgery. CABG was performed by experienced staff surgeon (S.A.B.) using cardiopulmonary bypass (CPB) and cold crystalloid cardioplegia with LIMA to LAD and vein grafts to obtuse marginal artery and PDA. LIMA was dissected from its origin to the bifurcation using pedicled in situ technique, and after cutting off it had a satisfactory blood flow. There was no doubt in the good %U http://www.hindawi.com/journals/srp/2014/574346/