| A Case of Hornerfs Syndrome after Coronary Artery Bypass Graft Surgery |
(Department of Cardiovascular Surgery, Oji General Hospital, Tomakomai, Japan)
| Tatsuya Murakami |
Hiroki Kato |
Yutaka Makino |
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Hornerfs syndrome is a rare complication after open heart surgery via median sternotomy. To date only two cases have been reported in Japan. A 77-year-old woman presented to our hospital, complaining of worsening effort angina. She was found to have old inferior myocardial infarction, severe triple vessel diseases and ischemic mitral regurgitation. At operation, the patient was placed in the supine position with the left arm abducted to approximately 80 degrees to harvest the left radial artery. At the same time, the left internal thoracic artery was dissected free from the chest wall using a Delacroix-Chevalier retractor following median sternotomy. She underwent mitral ring annuloplasty and three coronary artery bypass graftings on cardiopulmonary bypass. Her immediate postoperative course was uneventful. On postoperative day (POD) 2, however, left Hornerfs syndrome became apparent with the classical triad: ptosis, miosis and enophthalmos. She subsequently complained of pain and numbness of the left arm. A chest X-ray film on POD 4 revealed posterior fracture of the left first rib, suggesting that the fracture fragments or the associated hematoma could have caused direct injury of the cervical sympathetic trunk and the brachial plexus. On POD 21, the discharge day, the neurological symptoms still persisted mildly but spontaneously resolved within 6 months. In order to prevent such complications, we should treat the sternum and the ribs with great caution when using a sternal retractor and harvesting the internal thoracic arteries.
@Jpn. J. Cardiovasc. Surg. 36: 273-276 (2007) |
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