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Intraoperative New Regional Wall Motion Abnormalities Following Aortic or Mitral Valve Surgery: A Case Series and Management Algorithm

Published:April 20, 2022DOI:https://doi.org/10.1053/j.jvca.2022.03.038
      REGIONAL WALL MOTION ABNORMALITIES (RWMAs) diagnosed by transesophageal echocardiography (TEE) may occur after valvular surgery and may be caused by various mechanisms such as air or calcium embolism, coronary spasm, poor myocardial protection, or coronary artery occlusion. Although coronary artery occlusions have been described, either after aortic or mitral valve surgery,
      • Hiltrop N
      • Bennett J
      • Desmet W
      • et al.
      Circumflex coronary artery injury after mitral valve surgery: A report of four cases and comprehensive review of the literature.
      ,
      • El-Ebrahim KE
      • OO Al-Radi
      • Zaher ZF
      • et al.
      Iatrogenic coronary artery compromise post non-coronary cardiac surgery in patients with normal coronaries.
      it may be difficult to differentiate the different etiologies of new RWMAs mentioned above from coronary injuries. The purpose of this case series is to differentiate between the different etiologies of RWMAs after valvular surgery from the rare occurrence of coronary occlusion.

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      References

        • Hiltrop N
        • Bennett J
        • Desmet W
        • et al.
        Circumflex coronary artery injury after mitral valve surgery: A report of four cases and comprehensive review of the literature.
        Catheter Cardiovasc Interv. 2017; 89: 78-92
        • El-Ebrahim KE
        • OO Al-Radi
        • Zaher ZF
        • et al.
        Iatrogenic coronary artery compromise post non-coronary cardiac surgery in patients with normal coronaries.
        Heart Surg Forum. 2020; 23: E221-E224
        • Turillazzi E
        • Giammarco GD
        • Neri M
        • et al.
        Coronary ostia obstruction after replacement of aortic valve prosthesis.
        Diagn Pathol. 2011; 6: 72
        • Aybek T
        • Risteski P
        • Miskovic A
        • et al.
        Seven years’ experience with suture annuloplasty for mitral valve repair.
        J Thorac Cardiovasc Surg. 2006; 131: 99-106
        • Acar C.
        Re: Injury to the circumflex coronary artery following mitral valve repair.
        Eur J Cardiothorac Surg. 2007; 32: 818
        • Formica F
        • Bamodu OA
        • Mariani S
        • et al.
        Post-valvular surgery multi-vessel coronary artery spasm: A literature review.
        Int J Cardiol Heart Vasc. 2016; 10: 32-38
        • Jang MS
        • Choi JH
        • Choi YI
        • et al.
        Acute coronary obstruction after aortic valve replacement surgery and role of transesophageal echocardiography.
        Anesth Pain Med. 2017; 12: 348-351
        • Fernandez A
        • El-Diasty MM
        • Martinez A
        • et al.
        A simple technique to rule out occlusion of right coronary artery after aortic valve surgery.
        Ann Thorac Surg. 2011; 92: 2281-2282
        • Umran S
        • Chetty G
        • Sarkar PK.
        Acute right coronary ostial stenosis during aortic valve replacement.
        Int J Prev Med. 2012; 3: 295-297
        • Farid S
        • Page A
        • Howell N
        • et al.
        Coronary ostial compromise in aortic valve replacement: An avoidable complication.
        Asian Cardiovasc Thorac Ann. 2015; 23: 535-542
        • Spina R
        • Khalique O
        • George I
        • et al.
        Acute left main stem coronary occlusion following transcatheter aortic valve replacement in a patient without recognized coronary obstruction risk factors: A case report.
        Eur Heart J Case Rep. 2018; 2: yty112
        • Chambers J
        • Roxburgh J
        • Blauth C
        • et al.
        A randomized comparison of the MCRI On-X and Carbomedics Top Hat bileaflet mechanical replacement aortic valves: Early postoperative hemodynamic function and clinical events.
        J Thorac Cardiovasc Surg. 2005; 130: 759-764
        • Scarsini R
        • De Maria GL
        • Ciofani J
        • et al.
        Coronary injury in mitral and aortic valve surgery: A case series using optical coherence tomography.
        Ann Thorac Surg. 2020; 109: e171-e174
        • Bargagna M
        • Trumello C
        • Sala A
        • et al.
        Left circumflex artery injury after mitral valve surgery: An algorithm management proposal.
        Ann Thorac Surg. 2021; 111: 899-905
        • Kaklikkaya I
        • Yeginoglu G.
        Damage to coronary arteries during mitral valve surgery.
        Heart Surg Forum. 2003; 6: E138-E142
        • Ender J
        • Gummert J
        • Fassl J
        • et al.
        Ligation or distortion of the right circumflex artery during minimal invasive mitral valve repair detected by transesophageal echocardiography.
        J Am Soc Echocardiogr. 2008; 21 (e4-5): 408
        • Cornu E
        • Lacroix PH
        • Christides C
        • et al.
        Coronary artery damage during mitral valve replacement.
        J Cardiovasc Surg (Torino). 1995; 36: 261-264
        • Tovar EA
        • Blau N
        • Borsari A
        • et al.
        Severe deformity of a Palmaz-Schatz stent after normal surgical manipulation.
        Ann Thorac Surg. 1997; 63: 220-221
        • Chauvette V
        • Bouchard D
        • Pellerin M
        • et al.
        Commentary: Mitral valve annuloplasty and circumflex artery injury: A fewer stitches better?.
        J Thorac Cardiovasc Surg Tech. 2020; 5: 31-33
        • Raza JA
        • Rodriguez E
        • Miller MJ.
        Successful percutaneous revascularization of circumflex artery injury after minimally invasive mitral valve repair and left atrial cryo-MAZE.
        J Invasive Cardiol. 2006; 18: E282-E287
        • Grande AM
        • Fiore A
        • Massetti M
        • et al.
        Iatrogenic circumflex coronary lesion in mitral valve surgery: Case report and review of the literature.
        Tex Heart Inst J. 2008; 35: 179-183
        • Ender J
        • Selbach M
        • Borger MA
        • et al.
        Echocardiographic identification of iatrogenic injury of the circumflex artery during minimally invasive mitral valve repair.
        Ann Thorac Surg. 2010; 89: 1866-1872
        • Ahmad TA
        • Nudy M
        • Pabst D
        • et al.
        Mitral valve repair complicated by circumflex coronary artery occlusion: An under-recognized but potentially deadly complication.
        Cardiovasc Revasc Med. 2018; 19: S77-S81