Right coronary artery injury after tricuspid ring annuloplasty

Jean-Paul Remadi^*, Solesne Vasse, A Nzomvuama

Department of Cardiology Surgery, Cardiac Surgery Unit, Amiens University Hospital, France

*Corresponding Author: Jean-Paul Remadi, Department of Cardiology Surgery, Cardiac Surgery Unit, Amiens University Hospital, France, E-mail: jpvmrema@gmail.com

Received date: April 25, 2022; Accepted date: June 23, 2022; Published date: July 02, 2022

Citation: Remadi JP, Vasse S, Nzomvuama A. (2022) Right Coronary Artery Injury after Tricuspid Ring Annuloplasty. J Card Cardi Sur. 1(2):13.

Copyright: © 2022 Remadi JP. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords

Tricuspid ring; Coronary artery

Abstract

A 60 years old man was operated on for an aortic valve replacement associated with a tricuspid ring annuloplasty. An ischemic event occurred and the tricuspid ring was removed.

Description

A 60 years old man was operated on for a severe aortic insufficiency. The tricuspid annulus diameter was 45 mm without tricuspid insufficiency. An Abbot mechanical aortic valve replacement associated with a prophylactic ring annuloplasty was performed.

An ischemic event occurred one hour after the transfer to the intensive care unit without hémodynamique instability. Therefore a coronarography was urgently performed. A kinking of the second segment of the right coronary was found (RCA), well seen in Figure 1.

Figure 1: Right coronary injury by the tricuspid annulus.

The tricuspid ring was very close to the RCA. The patient was immediately re-operated and the ring was removed without any other procedure. The corchromatographowed a restoration of the RCA shape (Figure 2). The follow-up was uneventful and the ischemic event was fixed. The echocardiography before discharge at one week showed a left ventricular ejection fraction of 50% without dyskinesia.

Figure 2: Right coronary normal after tricuspid annulus removal.

Such events are unfrequent but described in the literature [1-3]. The prognosis is worse when the right ventricular is injured by the ischemic event [2]. This case is original because the resolution of the problem was obtained by the ring ablation. A RCA bypass grafting or dilatation with or without drug-eluting stenting are most often performed and the annulus ring is not usually removed [1-3].

References

01. Miura Y, Takeuchi R, Terai Y, Nakai M, Yamazaki F, et al. Right ventricular infarction caused by tricuspid ring annuloplasty. Gen Thorac Cardiovasc Surg. 65(8): 463-5 (2017).

02. Santavy P, Simek M, Troub M, Lonsky V. Right coronary artery obstruction by tricuspid anuloplasty ring. Eur J Cardiothorac Surg. 39(3): 416 (2011).

03. Díez-Villanueva P, Gutiérrez-Ibañes E, Cuerpo-Caballero GP, Sanz-Ruiz R, Abeytua M, et al. Direct injury to right coronary artery in patients undergoing tricuspid annuloplasty. Ann Thorac Surg. 97(4): 1300-5 (2014).