Hsin-Tzu Liu ^{a, b}, Yue-Shiung Wang ^a, Hann-Chorng Kuo ^a

^aDepartment of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^bInstitute of Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan

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Pei-Chun Lai ^{a, b}, Te-Chao Fang ^{c, d}, Ted H. Chiu ^{a, e}, Yen-Ta Huang ^{a, d, f}

^aInstitute of Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan
^bDepartment of Pediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^cDepartment of Medicine, Tzu Chi University, Hualien, Taiwan
^dDepartment of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^eDepartment of Pharmacology, Tzu Chi University, Hualien, Taiwan
^fSurgical Critical Care Unit, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

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Cay-Huyen Chen ^{a, b}, Pei-Shan Tsai ^c, Chun-Jen Huang ^{a, b}

^aDepartment of Anesthesiology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
^bSchool of Medicine, Tzu Chi University, Hualien, Taiwan
^cCollege of Nursing, Taipei Medical University, Taipei, Taiwan

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Jimmy Ong ^a, Hsien-Yong Lai ^a, Li-Fu Cheng ^b, Pei-Chin Lin ^a, Chia-Ling Lee ^a, Tsung-Ying Chen ^a, Po-Kai Wang ^a

^aDepartment of Anesthesiology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^bDepartment of Surgery, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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Giou-Teng Yiang

Department of Emergency Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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Han-Ju Chen ^a, Huan-Sen Chen ^a, Yen-Liang Chang ^{a, b}, Yi-Yiing Wu ^c

^aDepartment of Otolaryngology-Head and Neck Surgery, Cathay General Hospital, Taipei, Taiwan
^bCollege of Medicine, Fu Jen Catholic University, Taipei, Taiwan
^cDepartment of Pathology, Cathay General Hospital, Taipei, Taiwan

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Cheng-Yu Chien ^a, Chang-Jen Yang ^b, Chorng-Jang Lay ^a, Chen-Chi Tsai ^a

^aSection of Infectious Disease, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^bSection of Orthopedics, Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^cSchool of Medicine, Tzu Chi University, Hualien, Taiwan

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Erdogan Gultekin ^a, Omer N. Develioglu ^b, Kursat Yelken ^c, Murat Yener ^a, Hakan Koleli ^b

^aDepartment of Otorhinolaryngology, Faculty of Medicine, Namık Kemal University, Tekirdag, Turkey
^bDepartment of Otorhinolaryngology, Taksim Education and Research Hospital, Istanbul, Turkey
^cDepartment of Otorhinolaryngology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey

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Rong-Feng Chen, Chih-Hao Lu

Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan

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Chin-En Chen ^{a, b}, Rei-Jahn Juhn ^a

^aDepartment of Orthopedic Surgery, Golden Hospital, Pingtung, Taiwan
^bDepartment of Nursing, Tajen University, Pingtung, Taiwan

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Tzyy-Ling Chuang ^a, Yuh-Feng Wang ^{a, b}, Chun-Liang Lai ^{b, c}

^aDepartment of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^bSchool of Medicine, Tzu Chi University, Hualien, Taiwan
^cDivision of Chest and Critical Care, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

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Jiann-Jy Chen ^{a, b, c}, Dem-Lion Chen ^d

^aDepartment of Otorhinolaryngology, Taoyuan Hospital, Department of Health, Executive Yuan, Taoyuan, Taiwan
^bFaculty of Medicine, School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
^cDepartment of Medical Imaging, Taipei Medical University & Shuang Ho Hospital, Taipei, Taiwan
^dG-Home Otorhinolaryngologic Clinic, Kaohsiung, Taiwan

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Yaw-Ren Hsu ^{a, b}, Jeng-Hsiu Hung ^{a, b}, Chung-Tai Yue ^{b, c}

^aDepartment of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
^bSchool of Medicine, Tzu Chi University, Hualien, Taiwan
^cDepartment of Pathology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan

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Yuan-Chieh Lee ^{a, b, c}

^aDepartment of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^bDepartment of Medicine, Tzu Chi University, Hualien, Taiwan
^cDepartment of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan

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Li-Chin Sung ^{a, b}, Bee-Song Chang ^c, Ji-Hung Wang ^b

^aDivision of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
^bDivision of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^cDivision of Cardiovascular Surgery, Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

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Abstract

We report a diabetic man with prior coronary artery bypass grafting (CABG) who underwent coronary angiography (CAG) because of medically refractory unstable angina. CAG revealed severe stenosis of the left circumflex artery (LCX) and the right coronary artery (RCA), patent artery graft to the left anterior descending artery and total occlusion of saphe-nous venous grafts to the RCA and LCX. During percutaneous coronary intervention (PCI), the patient suffered from circulatory collapse. We postponed the procedure and placed an intra-aortic balloon pump (IABP); however, the patient remained hemodynamically unstable. He was rescued by PCI with extracorporeal membrane oxygenation (ECMO) support. No major cardiovascular event was reported during the 6-month follow-up period since treatment. We have learned that PCI in patients with prior CABG and severe left ventricular dysfunction has a high risk of inducing cardiogenic shock when an IABP is used. ECMO should be considered for these patients when PCI is performed on the vessels that supply only viable and contractile myocardium.

Keywords

Cardiogenic shock; Coronary artery bypass grafting; Extracorporeal membrane oxygenation; Percutaneous coronary intervention

Yu-Hsing Lin , Hsu-Cheuh Ho

Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

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Yi-Yin Huang ^a, Chin-Chung Chen ^b, Yung-Kang Wu ^c

^aDivision of Endocrinology and Metabolism, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taiwan
^bDivision of Nephrology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taiwan
^cDepartment of Surgery, Buddhist Tzu Chi General Hospital, Taichung Branch, Taiwan

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Hsin-Chi Chen ^a, Willie Chen ^b, Pao-Sheng Lee ^b, Ming-Chi Chiang ^a, Juin-Shom Liu ^b

^aDepartment of Radiology, Nan-Men General Hospital, Hsinchu, Taiwan
^bDepartment of Surgery, Nan-Men General Hospital, Hsinchu, Taiwan

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Yung-Hsiang Hsu

Department of Pathology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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