Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
Ann Thorac Surg. 2014 Apr;97(4):1300-5. doi: 10.1016/j.athoracsur.2013.12.021. Epub 2014 Feb 14.
Direct injury to the right coronary artery as a result of reparative operation on the tricuspid valve is a rare, probably underdiagnosed, but serious complication, which often involves dramatic clinical consequences. So far, only five cases have been described in the literature.
We describe our single-center experience of this complication, and review and analyze relevant clinical and anatomic considerations related to this entity. Cases previously reported in the literature were also reviewed.
We describe four cases of direct injury to the right coronary artery in patients undergoing tricuspid annuloplasty (DeVega annuloplasty, 3; ring annuloplasty, 1) in our institution since 2005. All patients had right ventricular dilatation and severely dilated tricuspid annulus. Right coronary artery occlusion always occurred between the right marginal artery and the crux of the heart. Patients presented with hemodynamic or electrical instability. Coronary flow could be restored in 2 patients (percutaneously 1; surgically 1), both of whom finally survived, while it was not technically possible in the other 2 (1 died).
Occlusion of the right coronary artery in patients undergoing tricuspid annuloplasty is a rare complication that may occur if great annulus dilatation is present, thus altering both normal annular geometry and the relationship between the right coronary artery and the tricuspid annulus, particularly when DeVega annuloplasty is performed. Such an entity should be considered in the immediate postoperative period in an unstable patient, especially when complementary tests support this diagnosis. Prompt recognition and treatment can positively affect the patient's outcome, most often by means of an emergency revascularization strategy.
修复三尖瓣手术时直接损伤右冠状动脉是一种罕见的、可能诊断不足但严重的并发症，常导致戏剧性的临床后果。迄今为止，文献中仅描述了 5 例。
我们描述了该并发症在我院的单中心经验，并回顾和分析了与该疾病相关的临床和解剖学注意事项。同时也回顾了文献中报道的相关病例。
自 2005 年以来，我院在施行三尖瓣环成形术（DeVega 环成形术 3 例，环成形术 1 例）的患者中发生了 4 例右冠状动脉直接损伤。所有患者均有右心室扩张和严重扩张的三尖瓣环。右冠状动脉闭塞均发生在右缘支和心脏十字交叉处之间。患者表现为血流动力学或电不稳定。2 例患者（经皮 1 例，手术 1 例）成功恢复了冠状动脉血流，最终均存活，而另外 2 例患者因技术原因无法恢复（1 例死亡）。
在行三尖瓣环成形术的患者中，右冠状动脉闭塞是一种罕见的并发症，如果存在巨大瓣环扩张，可能会发生这种并发症，从而改变正常的瓣环几何形状和右冠状动脉与三尖瓣环之间的关系，尤其是施行 DeVega 环成形术时。对于不稳定的患者，尤其是当辅助检查支持该诊断时，应在术后立即考虑到这种并发症。及时识别和治疗可以显著改善患者的预后，最常通过紧急血运重建策略。
