Poon Shi Sum, George Joseph, Obaid Daniel, Kumar Pankaj
Department of Cardiac Surgery, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, UK.
Department of Interventional Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, UK.
Eur Heart J Case Rep. 2020 Nov 15;4(6):1-4. doi: 10.1093/ehjcr/ytaa328. eCollection 2020 Dec.
Iatrogenic right coronary artery (RCA) injury is a rare complication of tricuspid valve annuloplasty. Given that surgical intervention is increasingly favoured for tricuspid regurgitation, it is of great importance to recognize potential complications following tricuspid valve surgery.
A 72-year-old man underwent surgical mitral and tricuspid valve repair. The early post-operative course was complicated by recurrent ventricular fibrillation episodes. Due to haemodynamic instability, a re-sternotomy and another cardiopulmonary bypass run were required. The patient subsequently underwent coronary angiography study which confirmed RCA occlusion. The occluded posterior left ventricular (PLV) branch was reopened by balloon angioplasty. However, despite multiple attempts it was not possible to pass a coronary guide wire into the posterior descending artery (PDA). An intravascular ultrasound examination revealed that the ostium of the PDA was compressed by external factors leaving a narrow slit-like appearance with no accessible lumen. Subsequently, a drug-eluting stent was placed into the PLV branch. The PDA was not accessible on repeated re-canalization attempts. The patient later successfully recovered from the right ventricular myocardial infarction.
Right coronary artery occlusion should be considered as a differential diagnosis for significant rhythm disturbances and haemodynamic instability in the peri- and post-operative period following tricuspid valve annuloplasty. A low threshold for diagnostic angiography is needed to avoid potential delay in life-saving revascularization.
医源性右冠状动脉（RCA）损伤是三尖瓣环成形术罕见的并发症。鉴于手术干预越来越多地用于治疗三尖瓣反流，认识三尖瓣手术后的潜在并发症非常重要。
一名72岁男性接受了二尖瓣和三尖瓣修复手术。术后早期出现反复室颤发作，导致病情复杂。由于血流动力学不稳定，需要再次开胸和进行另一次体外循环。患者随后接受冠状动脉造影检查，证实右冠状动脉闭塞。闭塞的左心室后支（PLV）通过球囊血管成形术重新开通。然而，尽管多次尝试，仍无法将冠状动脉导丝送入后降支动脉（PDA）。血管内超声检查显示，后降支动脉开口被外部因素压迫，呈狭窄的缝隙样外观，无可用管腔。随后，一枚药物洗脱支架被置入左心室后支。多次尝试重新开通后降支动脉均未成功。患者后来成功地从右心室心肌梗死中康复。
在三尖瓣环成形术围手术期和术后，右冠状动脉闭塞应被视为严重节律紊乱和血流动力学不稳定的鉴别诊断。需要有较低的诊断性血管造影阈值，以避免在挽救生命的血管重建中出现潜在延误。
