Iatrogenic Coronary Artery Compromise Post Non-Coronary Cardiac Surgery in Patients With Normal Coronaries
DOI:
https://doi.org/10.1532/hsf.2921Keywords:
Coronary, aortic, mitral, ASCAP, complicationsAbstract
Background: Unexpected events in cardiac surgery may increase morbidity and mortality. We present rare complications related to coronary arteries in non-coronary cardiac surgery in adults and pediatrics.
Patients and Methods: We retrospectively reviewed our surgical left-sided valve procedures and aortic root reconstruction for patients with documented coronary ostial injury or left circumflex artery (LCX) between January 2012 and December 2019.
Preoperative echocardiography was the standard investigation for all cases and other specific work ups were ordered, according to each case. Management by surgical or non-surgical intervention was planned, according to each complication. Postoperative hemodynamics and mortality rate were the outcomes of interest.
Results: Seven patients were found to have coronary artery compromise post left-sided valve procedures and aortic root reconstruction in adults and children. The details are shown in Table 1. The complications were in 2 patients post-mitral valve (MV) repair, 3 patients post-aortic (AV) replacement, 2 pediatric patients, 1 post-aortic homograft, and the other post-repair of anomalous single coronary arising from the pulmonary artery (ASCAPA). Six patients were hemodynamically unstable. Five patients had intraoperative ischemic changes on electrocardiogram and echocardiography, while ventricular arrhythmias were documented in 3 patients. Two patients were treated with percutaneous coronary intervention to LCX and right coronary artery (RCA), while 4 patients required immediate surgery to graft the obtuse marginal branch of the LCX artery (1) and RCA (3). No revision to valvular procedure was done. With the exception of one, all patients survived.
Conclusion: A high index of suspicion is required to diagnose and rescue coronary complications post-valvular surgery and aortic root reconstruction.
References
Alqahtani F, Kawsara A, Hijazi M, Alkhouli M. 2017. Iatrogenic Circumflex Artery Stenosis Following Mitral Valve Repair. Cureus. Sep 12; 9(9):e1680.
Bernelli C, Bezante GP, Brunelli C, Balbi M. 2012. Iatrogenic left main coronary ostial stenosis after a Bentall procedure in an asymptomatic young man. Texas Heart Institute Journal. 39(3):393–397.
Ender J, Selbach M, Borger MA, et al. 2010. Echocardiographic identification of iatrogenic injury of the circumflex artery during minimally invasive mitral valve repair. Ann Thorac Surg 89: pp. 1866-1872.
Folkmann S, Mohr FW, Garbade J. 2014. Emergency PCI after occlusion of the circumflex artery due to minimally invasive mitral valve replacement in redo operation Acta Cardiol 64: 451-4.
Funada A, Mizuno S, Ohsato K, Murakami T, Moriuchi I, Misawa K. 2006. Three cases of iatrogenic coronary ostial stenosis after aortic valve replacement. Circ J. 70:1312–7.
Hiltrop N, Bennett J, Desmet W. 2017. Circumflex Coronary Artery Injury After Mitral Valve Surgery: A Report of Four Cases and Comprehensive Review of the Literature 89:78-92.
Kawamura A, Oshima Y, Maruo A, Matsuhisa H. 2012. Compression of an Anomalous Single Coronary Artery from Pulmonary Artery by Banding. European Journal for Cardio-Thoracic Surgery Official Journal of the European Association for Cardio-Thoracic Surgery 41: 59-61.
Mantilla R, Legarra JJ, Pradas G, Bravo M, Sanmartin M, Goicolea J. 2004. Percutaneous coronary intervention for iatrogenic occlusion of the circumflex artery after mitral anuloplasty Rev Esp Cardiol 57 :702-4.
Meursing DF, Boonswang NA, Dobrilovic N, Wait MA. 2006. Perioperative myocardial infarction secondary to dynamic circumflex coronary artery occlusion after mitral valve repair Tex Heart Inst J 33: 85-87.
Pillai JB, Pillay TM, Ahmad J. 2004. Coronary ostial stenosis after aortic valve replacement, revisited. Ann Thorac Surg. 78: 2169-2171.
Scarsini R, De Maria GL, Ciofani J, Jin XY, Sayeed R, Petrou M, Banning A. 2020. Coronary Injury in Mitral and Aortic Valve Surgery: A Case Series Using Optical Coherence Tomography. Ann Thorac Surg. Mar;109(3):e171-e174.
Shetty RS, Thareen JK, Ramaiah AK, Narayan R, Das JK, Chandrashekariah MM. 2015. Anomalous origin of single coronary artery from pulmonary artery: serendipitous diagnosis and successful surgical treatment. World J Pediatr Congenit Heart Surg 6: 108–110.
Ziakas AG, Economou FI, Charokopos NA, Pitsis AA, Parharidou DG, Papadopoulos TI, et al. 2010. Coronary ostial stenosis after aortic valve replacement successful treatment of 2 patients with drug-eluting stents. Tex Heart Inst J. 37:465–8.
