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European Heart Journal 1990 11(1):59-64;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

New bundle branch block after coronary artery bypass grafting— evaluation by CK-MB isoenzyme analysis and transoesophageal echocardiography

U. HAKE, S. IVERSEN, R. ERBEL*, M. DREXLER*, A. NEUFANG, J. MEYER* and H. OELERT

Division of Cardiothoracic and Vascular Surgery University Clinics Mainz, F.R.G.
*Department of Medicine II, Johannes Gutenberg Mainz, F.R.G.

Received 8 February 1989; revised 31 May 1989; .

Address for correspondence: Dr U. Hake, Division of Cardiothoracic and Vascular Surgery, Johannes Gutenberg University, Langenbeck-strasse I, D-6500 Mainz, West Germeny

Abstract

Twelve patients with a new complete bundle branch block after coronary artery bypass grafting underwent transoesophageal echocardiography (TEE). The results of TEE were compared with the pre-operative ventriculography, CK-MB isoenzyme time-release curves and clinical course.In eight patients with transient right bundle branch block or bifascicular block, low CK-MB activities and an uncomplicated postoperative course, transoesophageal echocardiography showed no new segmental wall motion abnormalities apart from a paradoxical septal movement in five. A persistent right or left bundle branch block was associated with either elevated isoenzyme activities, transoesophageal echocardiographic evidence of new segmental wall motion disturbance or both in four patients. One patient died because ojfatalarrhythmia and one suffered from a prolonged low cardiac output syndrome.A transient bundle branch block is usually a benign electrocardiographic finding. In case of a persistent bundle branch block associated with elevated CK MB isoenzymes, new left ventricular wall motion disturbances indicating a peri-operative myocardial injury are easily detected by transoesophageal echocardiography.

Key Words: Bundle branch block • coronary artery surgery • transoesophageal echocardiography • isoenzyme


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