Jailed Right Coronary Artery Presenting With Recurrent Pulseless Electrical Activity Arrest.
Eunice Dugan1, Farah Abdulhai2, Osamah Badwan2
1Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
JACC. Case Reports
|February 20, 2025
Summary
Aortic valve replacement can mask chronic coronary artery occlusion. Stenting a collateral artery can lead to cardiac arrest, emphasizing the need to identify coronary collaterals and the Bezold-Jarisch reflex.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Aortic valve replacement (AVR) is a common procedure for aortic valve disease.
- Coronary artery disease (CAD) can coexist with aortic valve disease.
- Late complications after AVR require careful consideration.
Observation:
- A 69-year-old woman experienced cardiac arrest post-circumflex artery stenting after AVR.
- Symptoms included hypotension, bradycardia, and cardiogenic shock.
- Postmortem examination revealed chronic right coronary artery occlusion.
Findings:
- The circumflex artery, acting as a collateral vessel, was jailed by stenting.
- This compromised collateral flow led to ischemic events.
- The Bezold-Jarisch reflex may have contributed to the hemodynamic instability.
Implications:
- Accurate definition of coronary collaterals is crucial before coronary interventions.
- Suspect late coronary occlusion following AVR, especially with atypical presentations.
- Recognize the Bezold-Jarisch reflex in patients with hemodynamic compromise after cardiac procedures.
Keywords:
anomalous coronary arteriescardiogenic shockpercutaneous coronary interventionpulseless electrical activity (PEA)More Related Videos
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