Urabe Daichi, Ide Masahiro, Matsuoka Motoyuki, Miyake Ryuichiro
Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, 2-2-1, Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
Anesthesia Associates of Kobe, Kobe, Japan.
JA Clin Rep. 2022 Oct 6;8(1):81. doi: 10.1186/s40981-022-00571-y.
Although rare, right coronary artery (RCA) injury is a serious complication of tricuspid annuloplasty (TAP) and warrants close attention. We report a case of ST elevation myocardial infarction secondary to iatrogenic RCA occlusion during minimally invasive cardiac surgery (MICS). Electrocardiography (ECG) revealed ST segment elevation in lead II. Transesophageal echocardiography (TEE) revealed inferior wall hypokinesis after cardiopulmonary bypass, and coronary angiography revealed peripheral RCA occlusion. Intraoperatively, we detected an atrioventricular groove deformity during the second surgical procedure. Wall motion and ECG abnormalities showed normalization after TAP was reestablished. Vigilant monitoring using TEE and ECG is important to detect intraoperative myocardial ischemia during MICS-TAP.
尽管罕见，但右冠状动脉（RCA）损伤是三尖瓣环成形术（TAP）的一种严重并发症，值得密切关注。我们报告一例在微创心脏手术（MICS）期间因医源性RCA闭塞继发ST段抬高型心肌梗死的病例。心电图（ECG）显示II导联ST段抬高。经食管超声心动图（TEE）显示体外循环后下壁运动减弱，冠状动脉造影显示RCA外周闭塞。术中，我们在第二次手术过程中检测到房室沟畸形。重建TAP后，壁运动和ECG异常恢复正常。在MICS-TAP期间，使用TEE和ECG进行 vigilant监测对于检测术中心肌缺血很重要。
