Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Oct 4;7(10):ytad483.
doi: 10.1093/ehjcr/ytad483. eCollection 2023 Oct.

Right coronary artery kinking after tricuspid valve annuloplasty: a case report

Affiliations
Case Reports

Right coronary artery kinking after tricuspid valve annuloplasty: a case report

Jeremy Florence et al. Eur Heart J Case Rep. .

Abstract

Background: Right coronary artery (RCA) injury is a rare complication of valvular surgery. However, complications should be considered, due to the significant clinical consequences. Identifying the coronary injury type and understanding the underlying pathophysiological mechanisms is essential to managing these complications.

Case summary: The case of a 59-year-old man who underwent conservative mitral valve surgery with tricuspid valve annuloplasty is presented. The early post-operative period was complicated by acute coronary syndrome with inferior persistent ST-segment elevation. A coronary angiogram confirmed critical RCA hazy lesions, raising the suspicion of coronary kinking. To confirm the underlying mechanism for these lesions and determine the best treatment strategy, endocoronary imaging was performed, revealing coronary kinking of the RCA. Based on the persistent acute ischaemia, a long-lasting drug-eluting stent (DES) was implanted in the lower and upper knees of the RCA. After angioplasty, electrocardiography showed regression of the ST-segment elevation. Ten days later, coronary angiography and optical coherence tomography showed good results. The patient recovered from his myocardial infarction.

Discussion: Only a few reports describe the use of endocoronary imaging for diagnosing coronary artery injury after tricuspid annuloplasty. The variety of lesion types that could underlie a single post-operative myocardial infarction makes endocoronary imaging a relevant technique to guide management strategy and optimize DES implantation.

Keywords: Cardiac surgery; Case report; Coronary angiography; Coronary kinking; Myocardial infarction; Optical coherence tomography; Tricuspid annuloplasty.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Preoperative coronary angiography. No significant lesion was detected on the right coronary artery (A) at 30° left anterior oblique and (B) at right anterior oblique with cranial angulation.
Figure 2
Figure 2
Postoperative electrocardiogram showing inferior ST elevation myocardial infarction with an anterolateral mirror image.
Figure 3
Figure 3
(A) Postoperative angiography. Hazy lesion of the upper knee and distal segment (upper/lower white arrows) and coronary twist aspect of the lower knee (red arrow). (B) Optical coherence tomography images. Coronary kinking (red arrow). Lesion-free area (yellow arrow). (C) Optical coherence tomography 3D image.
Figure 4
Figure 4
(A) Good angiographic control results associated with (B) an optical coherence tomography showing loss of kinking (red and white arrows). (C) 3D optical coherence tomography showing incomplete kinking upstream of the stenting.
Figure 5
Figure 5
Cardiac computed tomography showing the very close relationship between the right coronary artery and the tricuspid annuloplasty at the kinking site visualized by angiography (red arrow).

References

    1. Rivera R, Duran E, Ajuria M. Carpentier’s flexible ring versus De Vega’s annuloplasty. A prospective randomized study. J Thorac Cardiovasc Surg 1985;89:196–203. - PubMed
    1. Chikwe J, Itagaki S, Anyanwu A, Adams DH. Impact of concomitant tricuspid annuloplasty on tricuspid regurgitation, right ventricular function, and pulmonary artery hypertension after repair of mitral valve prolapse. J Am Coll Cardiol 2015;65:1931–1938. - PubMed
    1. Khorsandi M, Banerjee A, Singh H, Srivastava AR. Is a tricuspid annuloplasty ring significantly better than a De Vega’s annuloplasty stitch when repairing severe tricuspid regurgitation? Interact Cardiovasc Thorac Surg 2012;15:129–135. - PMC - PubMed
    1. Díez-Villanueva P, Gutiérrez-Ibañes E, Cuerpo-Caballero GP, Sanz-Ruiz R, Abeytua M, Soriano J, et al. . Direct injury to right coronary artery in patients undergoing tricuspid annuloplasty. Ann Thorac Surg 2014;97:1300–1305. - PubMed
    1. Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clin Proc 2010;85:483–500. - PMC - PubMed

Publication types

LinkOut - more resources