Iatrogenic Coronary Artery Compromise Post Non-Coronary Cardiac Surgery in Patients With Normal Coronaries

Authors

  • Khalid Ebrahim Al-Ebrahim, FRCSC Department, Cardiac Surgery Unit, King Abdulaziz University, Surgery, Jeddah, Saudi Arabi
  • Osman O. Al-Radi, FRCSC Department, Cardiac Surgery Unit, King Abdulaziz University, Surgery, Jeddah, Saudi Arabi
  • Zaher Faisal Zaher, MD Department of Pediatric Cardiologist/Intensivist, King Abdulaziz University, Pediatric Cardiac Center of Excellence, Jeddah, Saudi Arabia
  • Mohamed Hasan Ibrahim Department of Cardiology, Faculty of Medicine, Benha University, Al Qalyubia Governorate, Egypt
  • Ahmed Mohamed Dohain, MD Department of Pediatrics, Cairo University, Cardiology Division, Giza, Egypt
  • Ahmed Addelrahman Elassal, MD Department, Cardiac Surgery Unit, King Abdulaziz University, Surgery, Jeddah, Saudi Arabia

DOI:

https://doi.org/10.1532/hsf.2921

Keywords:

Coronary, aortic, mitral, ASCAP, complications

Abstract

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

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Published

2020-04-16

How to Cite

Al-Ebrahim, K., Al-Radi, O. O. ., Zaher, Z. F., Ibrahim, M. H., Dohai, A. M., & Elassal, A. A. (2020). Iatrogenic Coronary Artery Compromise Post Non-Coronary Cardiac Surgery in Patients With Normal Coronaries. The Heart Surgery Forum, 23(2), E221-E224. https://doi.org/10.1532/hsf.2921

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Section

Articles