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Published on: February 11, 2022
Severe tricuspid regurgitation with chordae tendinae rupture in CABG surgery
1Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China.
Insights
During cardiopulmonary bypass (CPB), a right atrial cannula can cause tricuspid valve injury. This case highlights severe tricuspid regurgitation resulting from chordae tendineae rupture due to cannula interaction.
Area of Science:
- Cardiovascular Surgery
- Echocardiography
- Cardiac Anatomy
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac surgical procedure.
- Cardiopulmonary bypass (CPB) is frequently utilized during CABG.
- Transesophageal echocardiography (TEE) is a valuable tool for intraoperative cardiac assessment.
Observation:
- A patient undergoing CABG with CPB experienced subtle tricuspid regurgitation initially.
- Post-CPB TEE revealed severe tricuspid regurgitation and prolapsed chordae tendineae.
- The tricuspid chordae tendineae rupture was attributed to the right atrial venous return cannula.
Findings:
- The right atrial venous return cannula, particularly with negative pressure for enhanced drainage, can lead to tricuspid valve leaflet adhesion.
- Adhesion of the tricuspid valve to the cannula increases the risk of chordae tendineae rupture and severe regurgitation.
- Intraoperative TEE is crucial for detecting such complications promptly.
Implications:
- This case underscores a potential iatrogenic cause of severe tricuspid regurgitation during CPB.
- Surgical techniques and cannula management should consider the risk of tricuspid valve injury.
- Further investigation into optimizing CPB cannula design and usage may be warranted to prevent valve damage.
Abstract:
A 58-year-old male patient was admitted with chest pain and was diagnosed with coronary heart disease. He was scheduled for coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Intraoperative real-time transesophageal echocardiography (TEE) showed that the tricuspid valves were well-aligned and subtle regurgitation. Real-time TEE after separation from CPB showed severe tricuspid regurgitation and prolapsed chordae tendineae. The tricuspid chordae tendineae rupture due to a right atrial venous return cannula. The use of negative pressure to improve venous drainage during CPB may result in the tricuspid valve being adsorbed to the cannula, increasing the likelihood of injury to the tricuspid valve.
