scholarly journals Avoidance of malignant arrhythmia caused by displacement of the right coronary artery ostium in surgical correction of supravalvular aortic stenosis

2019 ◽  
Vol 47 (11) ◽  
pp. 5702-5710
Author(s):  
Bo Peng ◽  
Qiang Wang

Objective This study was performed to identify the effects of different surgical approaches on the right coronary artery ostium in patients with congenital supravalvular aortic stenosis (SVAS) and to determine how to avoid surgically induced right coronary artery occlusion. Methods The surgical techniques and outcomes of 91 patients who underwent surgical treatment of SVAS from 2008 to 2015 in our institution were retrospectively reviewed to identify the causes of early death, reoperation, and extracorporeal membrane oxygenation (ECMO) support. Results Four perioperative deaths (Doty’s technique, n = 4), six cases of ECMO support (Doty’s technique, n = 4; Brom’s technique, n = 1; McGoon’s technique, n = 1), and eight reoperations (Doty’s technique, n = 5; Brom’s technique, n = 2; McGoon’s technique, n = 1) occurred. In cases of reoperation, adjustment of the shape and position of the right coronary sinus patch relieved the malignant arrhythmia. Conclusion Different surgical techniques have different effects on the right coronary artery. The shape of the patch inserted into the right coronary sinus should be carefully clipped to avoid distortion and ischemia of the right coronary artery.

2005 ◽  
Vol 101 (2) ◽  
pp. 309-310 ◽  
Author(s):  
Krishnakumar Nair ◽  
K.Mahadevan Krishnamoorthy ◽  
Jaganmohan A. Tharakan

2010 ◽  
Vol 89 (3) ◽  
pp. 961-963 ◽  
Author(s):  
Hiroyuki Nishi ◽  
Masataka Mitsuno ◽  
Hiroe Tanaka ◽  
Masaaki Ryomoto ◽  
Shinya Fukui ◽  
...  

1989 ◽  
Vol 78 (10) ◽  
pp. 1470-1474
Author(s):  
Jun-ichi HIRAI ◽  
Toshihiko MAEDA ◽  
Takanobu WAKASUGI ◽  
Takashi SAGA ◽  
Yoshihiro AKASHI ◽  
...  

Author(s):  
Lucian Calmac ◽  
◽  
Ruxandra-Nicoleta Horodinschi ◽  

We present the case of a 74 y.o. woman with multiple cardiovascular risk factors, admitted for worsening angina over the past three weeks. On admission she had no significant electrocardiographic and echocardiographic changes and a negative Troponin test. Coronary angiography revealed single vessel disease: severe stenosis of the right coronary artery (RCA) ostium (difficult to assess visually), 50% mid-vessel and 60% distal segment. The left anterior descending artery and circumflex artery had non-significant stenoses. Fractional flow reserve technique (FFR) was used to evaluate the RCA ostial lesion which proved to be significant, therefore angioplasty with three drug-eluting stents was performed for all three lesions of the right coronary artery, starting from the ostium. Due to its location, minimal aortic protrusion of the first stent occluded a small ostial branch which proved to be the conus artery and the patient developed mild transient angina during the procedure, but with good outcome regarding the intracoronary flow. After the angioplasty the patient presented anterior leads ST-elevation and developed mild chest pain with an increase in cardiac enzymes (CK-MB peak 39 U/L). Later on, she had two episodes of ventricular fibrillation with rapid defibrillation to sinus rhythm, with no further events or echocardiographic changes and no recurrent angina. The patient was started on amiodarone to prevent ventricular arrhythmias and continued double antiplatelet therapy with aspirin and clopidogrel. She was discharged six days later. In conclusion, although the conus branch is a small artery, its acute occlusion can have significant life-threatening complications.


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