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Surgically treated intraoperative coronary embolism.
1Cardiovascular Surgical Institute, Semmelweis University Budapest, Hungary.
The Thoracic and Cardiovascular Surgeon
|March 17, 2006
Summary
A case of intraoperative coronary embolism occurred during mitral valve replacement surgery. Prompt diagnosis and thrombectomy of the left anterior coronary artery were lifesaving, enabling easy patient recovery from cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Anesthesia
Background:
- Mitral valve replacement is a common cardiac surgery.
- Persistent atrial fibrillation increases stroke risk, even with anticoagulation.
- Transient ischemic attacks can precede major embolic events.
Observation:
- A patient developed cardiac dysfunction and cyanosis upon discontinuation of cardiopulmonary bypass during mitral valve replacement.
- Left ventricular anterior wall akinesia and elevated left atrial pressure (40 mm Hg) were noted.
- No atrial thrombus was detected preoperatively or intraoperatively.
Findings:
- Intraoperative coronary embolism was diagnosed.
- Multiple thrombi were successfully removed from the left anterior coronary artery (thrombectomy).
Implications:
- Intraoperative coronary embolism is a critical consideration in sudden cardiac deterioration during cardiac surgery.
- Timely diagnosis and intervention, such as thrombectomy, are crucial for patient survival.
- This case highlights the potential for embolism despite therapeutic anticoagulation and negative preoperative imaging.