Rapid Diagnosis and Management of Intraoperative Myocardial Infarction During Valvular Surgery: Using Intraoperative Transesophageal Echocardiography Followed by Emergency Coronary Artery Bypass Grafting Without Coronary Angiography

Nakajima, Hiroyuki; Ikari, Yuji; Kigawa, Ikutaro; Kitamura, Tadashi; Hatori, Mitsuharu; Tooda, Eiichi; Tanabe, Kengo; Miyairi, Takeshi; Hara, Kazuhiro

doi:10.1111/j.1540-8175.2005.00111.x

Cited by 19 publications

(24 citation statements)

References 7 publications

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“…Iatrogenic injury to the circumflex coronary artery following mitral annuloplasty has only been reported on rare occasions (11 published cases to date [1][2][3][4][5][6][7][8][9] including this report) but we believe that this event has been underrated. Early diagnosis of this complication can be difficult and its management still raises controversies [6][7][8].…”

Section: Introductionmentioning

confidence: 69%

Circumflex coronary artery injury following mitral annuloplasty treated by emergency angioplasty

Aubert¹,

Barthélémy²,

Landi³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Iatrogenic injury to the circumflex coronary artery following mitral annuloplasty is a potentially fatal complication. It can be clinically silent or else be responsible for a cardiogenic shock. The diagnosis should be suspected on EKG changes with segmental dysfunction of the lateral wall on the intraoperative echography. The author reports one case whose recognition relied on emergency angiography; the patient was successfully treated by angioplasty and stenting. The management of this complication remains controversial and the various treatment modalities are discussed.

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Section: Introductionmentioning

confidence: 69%

Circumflex coronary artery injury following mitral annuloplasty treated by emergency angioplasty

Aubert¹,

Barthélémy²,

Landi³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…Intraoperative TOE has been reported to be a helpful tool during mitral valve surgery, decreasing mortality rates by detecting myocardial compromise and RWMA in an early phase . Use of echocardiography, perioperatively and/or at the time of ischemia diagnosis, was reported in 68% of cases ( n = 30), and new or dynamic RWMA were detected in 80% ( n = 24).…”

Section: Discussionmentioning

confidence: 99%

“…Sometimes, however, there is no clear explanation. The following mechanisms have been suggested: occlusion of the artery by entrapment with a completely encircling fixation suture; obliteration of the artery caused by a suture passing through; coronary perforation; thrombotic occlusion due to laceration of the endothelium; vascular distortion caused by tissue retraction causing a dynamic or fixed occlusion, often reported after reconstruction of larger quadrangular valvular resections; laceration of the artery resulting in localized hemorrhage or subintimal hematoma leading to external compression; external compression by the annuloplasty ring and coronary spasm .…”

Section: Discussionmentioning

confidence: 99%

Circumflex coronary artery injury after mitral valve surgery: A report of four cases and comprehensive review of the literature

Hiltrop

Bennett

Desmet

2016

Cathet Cardio Intervent

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As the LCx is closely related to the mitral valve annulus, it is susceptible to perioperative injury. Various underlying mechanisms, predisposing factors, and therapeutic strategies have been suggested but disagreement exists. Using a MeSH terms-based PubMed search, 44 cases of mitral valve surgery-related LCx injury were detected, including our 4 cases. We provide a comprehensive review of current knowledge regarding mitral valve surgery-related left circumflex coronary artery (LCx) injury. Preoperative coronary angiography was performed in 55% (n = 24). Coronary abnormalities were present in 11% (n = 5). Coronary dominance was reported in 73% (n = 32), predominantly showing left (69%, n = 22) or balanced (19%, n = 6) circulations. Right coronary dominance was present in 12% (n = 4). Ischemia was detected in the perioperative or early postoperative phase in 86% (n = 30). Delayed symptoms were present in 14% (n = 5). Echocardiography demonstrated new regional wall motion abnormalities in 80% (n = 24), but was negative in 20% (n = 6) despite coronary compromise. Electrocardiography showed myocardial ischemia in 97% (n = 34), including regional ST-segment elevations in 68% (n = 23). Primary treatment was surgical in 42% (n = 15) and percutaneous in 58% (n = 21), reporting success ratios of 87% (n = 13) and 81% (n = 17), respectively. We confirm an augmented risk of mitral valve surgery-related LCx injury in balanced or left-dominant coronary circulations. Preoperative knowledge of coronary anatomy does not preclude LCx injury. An anomalous LCx arising from the right coronary cusp was identified as a possible specific high-risk entity. Electrocardiographic monitoring and intraoperative echocardiography remain paramount to ensure a timely diagnosis and treatment. © 2016 Wiley Periodicals, Inc.

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“…Použití jícnové echokardiografi e peroperačně může pomoci časně odhalit peroperační ischemii myokardu. 16 Přínosem v diagnostice iatrogenní ischemie způsobené chirurgicky je možnost použití hybridního sálu s provedením peroperační koronarografi e.…”

Section: Obrázek 3 Rekoronarografi E (Měsíc Po Operaci) -Rc S Iatrogeunclassified

Mitral valve ring as a rare cause of acute coronary syndrome

Juránek¹,

Nykl²

2010

Cor Vasa

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Juránek P, Nykl I. Prstenec mitrální chlopně jako raritní příčina akutního koronárního syndromu. Cor Vasa 2010;52:618-621. Mezi vzácné komplikace operace mitrální chlopně patří poškození věnčitých tepen. Ramus circumfl exus probíhá v těsné blízkosti mitrálního anulu. Iatrogenní poškození této tepny má poté za následek vznik non-aterosklerotické ischemické choroby srdeční s různou klinickou manifestací. V naší kasuistice popisujeme poškození ramus circumfl exus manifestující se akutním koronárním syndromem u pacientky s původně negativním koronarogramem. Klíčová slova: Chirurgie mitrální chlopně -Myokardiální ischemie -Akutní koronární syndromJuránek P, Nykl I. Mitral valve ring as a rare cause of acute coronary syndrome. Cor Vasa 2010;52:618-621.Rare complications of mitral valve surgery include damage to the coronary arteries. Left circumfl ex coronary artery (LCx) is in close proximity to the mitral annulus. Iatrogenic injury to this artery then gives rise to non-atherosclerotic coronary heart disease with diff erent clinical manifestations. In our case report we present injury to the LCx manifesting by acute coronary syndrome in a patient with initially negative coronary angiography.

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Rapid Diagnosis and Management of Intraoperative Myocardial Infarction During Valvular Surgery: Using Intraoperative Transesophageal Echocardiography Followed by Emergency Coronary Artery Bypass Grafting Without Coronary Angiography

Cited by 19 publications

References 7 publications

Circumflex coronary artery injury following mitral annuloplasty treated by emergency angioplasty

Circumflex coronary artery injury following mitral annuloplasty treated by emergency angioplasty

Circumflex coronary artery injury after mitral valve surgery: A report of four cases and comprehensive review of the literature

Mitral valve ring as a rare cause of acute coronary syndrome

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