Decision making of iatrogenic coronary embolism after SAVR: a case report
Abstract Background Acute coronary artery obstruction is a rare but lethal complication of surgical aortic valve replacement (SAVR), which may be caused by embolization of resected native tissue such as calcium plaque, thrombus, or perivalvular aortic tissue like fat embolus. Coronary artery bypass...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-02613-1 |
| _version_ | 1797259023805841408 |
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| author | Atsuyuki Mitsuishi Kazumasa Orihashi Yujiro Miura Ren Saito |
| author_facet | Atsuyuki Mitsuishi Kazumasa Orihashi Yujiro Miura Ren Saito |
| author_sort | Atsuyuki Mitsuishi |
| collection | DOAJ |
| description | Abstract Background Acute coronary artery obstruction is a rare but lethal complication of surgical aortic valve replacement (SAVR), which may be caused by embolization of resected native tissue such as calcium plaque, thrombus, or perivalvular aortic tissue like fat embolus. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the main treatment modalities. PCI is less invasive, but it is difficult to determine its feasibility intraoperatively. Case presentation We report an 86-year-old woman who had asymptomatic severe aortic stenosis. She had scleroderma with an intractable left leg ulcer and bilateral leg varices. Considering the possibility of the spread of infection from the leg wound, SAVR was performed via right anterior thoracotomy to avoid complications such as mediastinitis. Coronary artery occlusion was suspected after weaning of cardiopulmonary bypass in the operation room due to asynergy with ST elevation and new severe mitral regurgitation. Transoesophageal echocardiography (TEE) helped diagnose coronary obstruction by embolus based on the degree of stenosis and the movement of the stenosis site. Percutaneous catheter intervention was performed successfully to restore coronary perfusion. Conclusion TEE facilitated the diagnosis of coronary artery stenosis caused by an embolus and helped in determining the feasibility of percutaneous catheter intervention, thus allowing us to choose PCI over CABG as a less invasive surgery. This is especially invaluable in cases where obtaining a saphenous graft for CABG is difficult or where CABG would have required conversion from minimally invasive surgery (anterolateral approach) to median sternotomy. |
| first_indexed | 2024-04-24T23:02:50Z |
| format | Article |
| id | doaj.art-a0246df53b644ff583ba6c30e02b218e |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-24T23:02:50Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-a0246df53b644ff583ba6c30e02b218e2024-03-17T12:38:00ZengBMCJournal of Cardiothoracic Surgery1749-80902024-03-011911610.1186/s13019-024-02613-1Decision making of iatrogenic coronary embolism after SAVR: a case reportAtsuyuki Mitsuishi0Kazumasa Orihashi1Yujiro Miura2Ren Saito3Department of Cardiovascular Surgery, Kochi Medical School HospitalDepartment of Anesthesiology and Intensive Care Medicine, Kochi Medical School HospitalDepartment of Cardiovascular Surgery, Kochi Medical School HospitalDepartment of Cardiovascular Surgery, Kochi Medical School HospitalAbstract Background Acute coronary artery obstruction is a rare but lethal complication of surgical aortic valve replacement (SAVR), which may be caused by embolization of resected native tissue such as calcium plaque, thrombus, or perivalvular aortic tissue like fat embolus. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the main treatment modalities. PCI is less invasive, but it is difficult to determine its feasibility intraoperatively. Case presentation We report an 86-year-old woman who had asymptomatic severe aortic stenosis. She had scleroderma with an intractable left leg ulcer and bilateral leg varices. Considering the possibility of the spread of infection from the leg wound, SAVR was performed via right anterior thoracotomy to avoid complications such as mediastinitis. Coronary artery occlusion was suspected after weaning of cardiopulmonary bypass in the operation room due to asynergy with ST elevation and new severe mitral regurgitation. Transoesophageal echocardiography (TEE) helped diagnose coronary obstruction by embolus based on the degree of stenosis and the movement of the stenosis site. Percutaneous catheter intervention was performed successfully to restore coronary perfusion. Conclusion TEE facilitated the diagnosis of coronary artery stenosis caused by an embolus and helped in determining the feasibility of percutaneous catheter intervention, thus allowing us to choose PCI over CABG as a less invasive surgery. This is especially invaluable in cases where obtaining a saphenous graft for CABG is difficult or where CABG would have required conversion from minimally invasive surgery (anterolateral approach) to median sternotomy.https://doi.org/10.1186/s13019-024-02613-1Acute coronary syndromeCoronary artery obstructionSurgical aortic valve replacementTransesophageal echocardiographyAortic stenosisCase report |
| spellingShingle | Atsuyuki Mitsuishi Kazumasa Orihashi Yujiro Miura Ren Saito Decision making of iatrogenic coronary embolism after SAVR: a case report Journal of Cardiothoracic Surgery Acute coronary syndrome Coronary artery obstruction Surgical aortic valve replacement Transesophageal echocardiography Aortic stenosis Case report |
| title | Decision making of iatrogenic coronary embolism after SAVR: a case report |
| title_full | Decision making of iatrogenic coronary embolism after SAVR: a case report |
| title_fullStr | Decision making of iatrogenic coronary embolism after SAVR: a case report |
| title_full_unstemmed | Decision making of iatrogenic coronary embolism after SAVR: a case report |
| title_short | Decision making of iatrogenic coronary embolism after SAVR: a case report |
| title_sort | decision making of iatrogenic coronary embolism after savr a case report |
| topic | Acute coronary syndrome Coronary artery obstruction Surgical aortic valve replacement Transesophageal echocardiography Aortic stenosis Case report |
| url | https://doi.org/10.1186/s13019-024-02613-1 |
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