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Septal branch right ventricular fistula: a complication in coronary artery snaring
K Tanemoto1, K Kuroki, Y Kanaoka
1Department of Cardiovascular Surgery, Iwakuni National Hospital, Japan. kaztane@enjoy.ne.jp
Insights
A rare complication of coronary artery bypass surgery, a septal branch right ventricular fistula, can occur after coronary snaring. Surgeons should consider this risk during aortic non-cross-clamping procedures.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Anatomy
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure for coronary artery disease.
- Minimally invasive techniques, including off-pump CABG without aortic cross-clamping, are increasingly utilized.
- Coronary snaring is a technique used in off-pump CABG to occlude coronary arteries temporarily.
Observation:
- A specific case of a septal branch right ventricular fistula is reported.
- This fistula developed as a complication following coronary snaring during CABG surgery.
- The procedure was performed without aortic cross-clamping.
Findings:
- The precise cause was trauma to a septal branch of the right coronary artery during the snaring procedure.
- Although the snaring suture needle tip is blunted to minimize injury, inadvertent damage to smaller vessels like septal branches remains a possibility.
- This represents a rare but significant complication of the coronary snaring technique.
Implications:
- This finding highlights the potential risks associated with coronary snaring, even with modified instruments.
- Awareness of this complication is crucial for cardiac surgeons performing off-pump CABG.
- Preventive strategies and prompt recognition are necessary to manage this rare fistula effectively.
Abstract:
We report a septal branch right ventricular fistula complicated after coronary snaring in coronary artery bypass surgery without aortic cross-clamping. The tip of the needle of the snaring suture is made blunt in order to decrease the risk of mechanical injury, but trauma to the septal branch is possible. This rare complication of snaring should be taken into consideration in performing aortic nonclamping coronary artery bypass surgery.