To the editor
We read with interest the case report by Ackah and
colleagues1.We previously reported, in a cohort study2, our experience in the management of coronary injury
post valve procedures. Mechanism and different etiologies of coronary
injury, which we called iatrogenic, post valve procedure were outlined
in the article. Prompt diagnosis is essential to save patient life in
such complication. High index of suspicion of coronary injury is the
best tool for early diagnosis. Such dreadful complication should come to
mind once there is difficulty of weaning, arrhythmias, ECG changes,
especially ST elevation, depression, or block. Intraoperative
confirmation of coronary injury is assisted by intraesophageal
echocardiography demonstration of new wall motion abnormality. We
encourage intraoperative diagnosis to avoid myocardial injury. 80%of
our patients were diagnosed and managed intraoperatively. Two patients
post-surgical aortic valve replacement (SAVR) showed inferior wall
ischemia by ECG and hypokinesia by TEE resulted in severe LV dysfunction
post weaning and requiring high inotropes and received saphenous vein
graft to the right coronary artery on a beating heart. One patient also,
post SAVR, was difficult to wean with recurrent ventricular
fibrillation, stabilized after IMA to LAD. Another old female,80years
old, postconventional mitral repair weaned on large doses of inotropes
and TEE showed new lateral wall hypokinesia, immediately improved after
saphenous vein graft to lateral obtuse marginal branch. Probably the
ring sutures were impinging on the circumflex coronary artery. Only one
middle aged lady, post minimal access mitral repair, experienced
ischemia in ICU, two hours post op, and was taken for coronary
catheterization which showed main circumflex narrowing and was
successfully stented. In Ackah and colleagues case report, the
circumflex lesion was evident preoperatively, more than moderate and
complicated by a thrombus. Prompt intraoperative diagnosis and
management was feasible without catheterization. Stenting would have
been safe without a revisit to the operating room3,4.
References
ckah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;3
ckah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;3
ckah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;3
9. SanchezRecalde A, GonzalezObeso E, Oliver JM. Bilateral cor-
onary artery occlusion after aortic valve replacement in a patient
with porcelain ascending aorta. Eur Heart J. 2007;28(13):1553.
https://doi.org/10.1093/eurheartj/ehl493
10. Ono N, Sawai T, Ishii H. Coronary ostial stenosis detected by
transesophageal echocardiography after aortic valve replace-
ment: a case report. JA Clin Rep orts . 2017;3(1):14. ht tps://doi.
org/10.1186/s40981-017-0083-8
How to cite this article: Ackah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;36:
38773880.
9. SanchezRecalde A, GonzalezObeso E, Oliver JM. Bilateral cor-
onary artery occlusion after aortic valve replacement in a patient
with porcelain ascending aorta. Eur Heart J. 2007;28(13):1553.
https://doi.org/10.1093/eurheartj/ehl493
10. Ono N, Sawai T, Ishii H. Coronary ostial stenosis detected by
transesophageal echocardiography after aortic valve replace-
ment: a case report. JA Clin Rep orts . 2017;3(1):14. ht tps://doi.
org/10.1186/s40981-017-0083-8
How to cite this article: Ackah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;36:
38773880.
Ackah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;
Ackah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;
Ackah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;
Ackah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;
Ackah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;
Ackah JK, Dastidar AG, Angelini GD,
Bruno VD. Acute coronary occlusion after surgical
replacement of the aortic valve treated with emergency off
pump coronary artery bypass grafting. J Card Surg. 2021;
- Ackah Jk, Dastidar AG, Angelini GD Bruno VD.Acute coronary occlusion
after surgical replacement of the aortic valve treated with off- pump
coronary artery bypass grafting. J Card Surg.2021;36: 3877-3880.
- Al-Ebrahim K, Al-Radi OO, Zaher ZF, Ibrahim MH, Dohain AM, Elassal AA.
Iatrogenic Coronary Artery Compromise Post Non-Coronary Cardiac
Surgery in Patients with Normal Coronaries. Heart Surg Forum. 2020 Apr
16;23(2):E221-E224. doi: 10.1532/hsf.2921. PMID: 32364918.
- Dello SA, Leus SJ, Tan MES, Otterspoor LC, Botman CJ. Percutaneous
coronary intervention of an iatrogenic occlusion of the circumflex
coronary artery after mitral valve replacement. Eur Heart J Acute
Cardiovasc Care. 2020 Aug;9(5):NP1-NP2. doi: 10.1177/2048872615623066.
Epub 2015 Dec 18. PMID: 26684791.
- Ziakas AG, Economou FI, Charokopos NA, Pitsis AA, Parharidou DG,
Papadopoulos TI, Parharidis GE. Coronary ostial stenosis after aortic
valve replacement: successful treatment of 2 patients with
drug-eluting stents. Tex Heart Inst J. 2010;37(4):465-8. PMID:
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