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[Successful patch angioplasty for the right coronary artery dissection following selective coronary perfusion]
M Nakano1, M Matsui, H Okuyama
1Department of Cardiovascular Surgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan.
Insights
Patch angioplasty successfully repaired a right coronary artery (RCA) dissection during heart surgery. This technique ensured a widely patent RCA, preventing future cardiac events and allowing full recovery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Techniques
- Interventional Cardiology
Background:
- A 56-year-old female patient presented with severe mitral and aortic stenosis, alongside atrial fibrillation with bradycardia-tachycardia syndrome.
- The patient underwent aortic valve replacement and mitral commissurotomy using hypothermic cardiopulmonary bypass and crystalloid cardioplegic arrest.
Observation:
- During the procedure, difficulty was encountered inserting the right coronary cannula, leading to dislodgement.
- A dissection of the right coronary artery (RCA) orifice and ascending aorta occurred during cardioplegic solution infusion.
- The dissection extended proximally into the RCA, necessitating extension of the aortotomy.
Findings:
- A Xenomedica pericardial patch was utilized to reconstruct the RCA orifice and close the dissected aortic wall.
- Postoperative coronary angiography confirmed a widely patent RCA orifice with excellent distal runoff.
- The patient experienced a successful outcome with complete resolution of angina and full physical activity capacity two years post-operation.
Implications:
- Patch angioplasty is a viable and effective technique for managing complex RCA orifice dissections during cardiac surgery.
- This case highlights the importance of meticulous surgical technique and the utility of pericardial patches in managing intraoperative complications.
- Successful repair of RCA dissection can lead to long-term freedom from symptoms and improved quality of life for patients undergoing complex cardiac procedures.
Abstract:
A case of successful patch angioplasty for the right coronary artery (RCA) orifice dissection following selective coronary perfusion is reported. A 56-year-old woman who had mitral restenosis, aortic stenosis, and atrial fibrillation with bradycardia-tachycardia syndrome was referred to our hospital for operation. The operation, which contained aortic valve replacement and mitral commissurotomy, was performed with hypothermic cardiopulmonary bypass and crystalloid cardioplegic arrest. The ascending aorta was opened, and selective coronary perfusion was performed. The right coronary cannula was difficult to insert and dislodged several times. At the second infusion of the cardioplegic solution, the right coronary orifice and ascending aortic wall was dissected. The dissection extended to the proximal RCA. The aortotomy was extended into the RCA beyond its orifice. The Xenomedica pericardial patch was used to enlarge the diameter of the RCA with closing the dissected cavity. Then the patch was brought onto the side of the aorta and the aortotomy was closed in the usual manner. Post operative coronary angiography revealed widely patent RCA orifice and good runoff. Two years after operation the patient is free of angina with unlimited physical activity.