Coronary sinus injury resulting from endarterectomy during multivessel bypass surgery

Area of Science:

• Cardiovascular Surgery
• Cardiac Anatomy
• Biomaterials in Medicine

Background:

• Coronary sinus injury is a rare but serious complication in cardiac surgery, often linked to catheter placement for retrograde cardioplegia.
• Potential causes include catheter perforation or high-perfusion pressure injuries to the coronary sinus.
• Surgical repair options include primary repair or over-sewing of the injured coronary sinus.

Observation:

• A case of coronary sinus stenosis occurred secondary to coronary artery endarterectomy during multivessel coronary artery bypass surgery.
• This procedure inadvertently injured the proximal middle cardiac vein (MCV), leading to its closure.
• The closure of the MCV resulted in significant coronary sinus obstruction.

Findings:

• The obstructed coronary sinus required a novel surgical approach for reconstruction.
• A CorMatrix tube graft, derived from decellularized extracellular matrix, was utilized to bypass the obstruction.
• The graft connected the coronary sinus to the right atrium, restoring flow.

Implications:

• This case demonstrates the successful application of a CorMatrix tube graft in managing complex coronary sinus obstruction.
• It highlights a potential solution for rare complications arising from cardiac procedures.
• The use of biomaterials like CorMatrix offers promising avenues for repairing cardiac structures and mitigating surgical risks.