Jacob Abiah, Hara Natalia, Goli Giridhara, Lall Kulvinder
Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, EC1A 7BE London, United Kingdom.
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, E1 2AD London, United Kingdom.
J Surg Case Rep. 2024 Jan 16;2024(1):rjad717. doi: 10.1093/jscr/rjad717. eCollection 2024 Jan.
Iatrogenic coronary artery dissection is a rare complication seen in 0.07% of coronary procedures. Presentations of this condition vary, ranging from signs of myocardial ischemia to rarer presentations of ventricular arrhythmias. We present a rare case of a 55-year-old patient with native aortic valve endocarditis who developed right coronary artery dissection (RCAD) in the immediate post-op period presenting with refractory ventricular fibrillation (VF). Emergency coronary angiogram revealed an extensive RCAD extending from the ostium to the mid-vessel as the cause of VF. A consensus between the cardiologists and the cardiac surgeons led to an emergency right coronary artery bypass graft (CABG) that resolved the VF. This case illustrates a rare presentation of iatrogenic RCAD and the successful management of the same. We highlight the importance of prompt detection via angiography in patients suspected of having coronary artery dissection and showcase the successful implementation of emergency CABG in a patient with unstable haemodynamics.
医源性冠状动脉夹层是一种罕见的并发症，在0.07%的冠状动脉手术中可见。这种情况的表现各不相同，从心肌缺血的症状到罕见的室性心律失常表现。我们报告一例罕见病例，一名55岁患有天然主动脉瓣心内膜炎的患者，术后即刻发生右冠状动脉夹层（RCAD），表现为难治性室颤（VF）。急诊冠状动脉造影显示广泛的右冠状动脉夹层从开口延伸至血管中段，这是室颤的原因。心脏病专家和心脏外科医生达成共识，进行了急诊右冠状动脉搭桥术（CABG），从而解决了室颤问题。本病例说明了医源性右冠状动脉夹层的罕见表现及其成功治疗。我们强调了对疑似冠状动脉夹层患者通过血管造影进行快速检测的重要性，并展示了在血流动力学不稳定患者中成功实施急诊冠状动脉搭桥术的情况。
