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Decision making of iatrogenic coronary embolism after SAVR: a case report
Atsuyuki Mitsuishi1, Kazumasa Orihashi2, Yujiro Miura3
1Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, Okohmachi, Kochi Prefecture, 783-8505, Japan. atmitsu@kochi-u.ac.jp.
Journal of Cardiothoracic Surgery
|March 16, 2024
Summary
Transesophageal echocardiography (TEE) aided in diagnosing coronary artery obstruction post-aortic valve replacement, guiding successful percutaneous coronary intervention (PCI) over traditional bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Acute coronary artery obstruction is a rare, life-threatening complication following surgical aortic valve replacement (SAVR).
- Embolization of native tissue or perivalvular material can cause this obstruction.
- Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are primary treatments, but PCI feasibility is challenging to assess intraoperatively.
Observation:
- An 86-year-old woman with severe aortic stenosis underwent SAVR due to comorbidities.
- Post-cardiopulmonary bypass, coronary artery occlusion was suspected based on electrocardiogram (ECG) changes and new mitral regurgitation.
- Transesophageal echocardiography (TEE) identified coronary obstruction due to embolus.
Findings:
- TEE accurately diagnosed coronary artery stenosis caused by an embolus.
- The imaging modality helped determine the feasibility of PCI.
- Successful PCI restored coronary perfusion, avoiding more invasive procedures.
Implications:
- TEE is crucial for diagnosing and guiding treatment of coronary obstruction post-SAVR.
- This approach facilitates the selection of less invasive PCI over CABG.
- TEE is particularly valuable when CABG is complex or requires conversion to a less minimally invasive surgical approach.
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