Daskalopoulos D A, Edwards W D, Driscoll D J, Danielson G K, Puga F J
J Thorac Cardiovasc Surg. 1983 Apr;85(4):546-51.
Three children with congenital heart disease died after surgical procedures involving the placement of valved extracardiac conduits; their deaths were caused by myocardial ischemia following coronary artery compression by the metallic stent of the conduit valve. The first and second patients died of acute myocardial ischemia or infarction during the immediate postoperative period, whereas the third patient died of chronic myocardial ischemia and progressive heart failure several months after the operation. In a fourth patient the problem of possible coronary artery compression was suspected on completion of the surgical procedure, and the valve stent was then repositioned away from the coronary artery; this resulted in marked hemodynamic improvement. Fatal myocardial ischemia from coronary artery compression is a rare but potential complication of valved extracardiac conduit placement in children with congenital heart disease. Preoperative assessment of coronary artery distribution is indicated in those patients with prior intrapericardial operations and subsequent pericardial adhesions. Such assessment in previously unoperated patients may be undertaken at the time of conduit operation. Proper conduit placement and intraoperative recognition of possible coronary artery compression by the conduit are important in preventing significant ischemic complications.
三名患有先天性心脏病的儿童在接受涉及植入带瓣心外管道的手术后死亡；他们的死亡是由于管道瓣膜的金属支架压迫冠状动脉导致心肌缺血所致。第一名和第二名患者在术后即刻死于急性心肌缺血或梗死，而第三名患者在术后数月死于慢性心肌缺血和进行性心力衰竭。第四名患者在手术结束时怀疑存在冠状动脉受压问题，随后将瓣膜支架重新放置在远离冠状动脉的位置；这导致了明显的血流动力学改善。冠状动脉受压导致的致命性心肌缺血是先天性心脏病患儿植入带瓣心外管道罕见但潜在的并发症。对于既往有心包内手术及随后心包粘连的患者，术前应评估冠状动脉分布情况。对于既往未手术的患者，可在植入管道手术时进行此类评估。正确放置管道以及术中识别管道可能对冠状动脉造成的压迫对于预防严重的缺血性并发症很重要。
