We report a case of intraoperative coronary embolism in a 52-year-old male patient
undergoing mitral valve replacement. The patient had persistent atrial fibrillation
and was treated with oral anticoagulants and, in spite of well controlled anticoagulation,
he suffered a transient ischemic attack. No intracardiac thrombus was found by transthoracic
echocardiography. Three weeks later open heart surgery was performed. During valve
surgery no thrombus was found in the left atrium. When cardiopulmonary bypass was
discontinued the heart function rapidly deteriorated and the heart swelled up, became
bluish, with left atrial pressure rising to 40 mm Hg. It was noticed that the anterior
surface of the left ventricle was not moving. Coronary embolism was considered. Multiple
thrombi were found and removed from the left anterior coronary artery. After successful
thrombectomy the patient came off the pump easily. Early and late postoperative course
were uneventful. Intraoperative coronary embolism should be considered when cardiac
function is deteriorating and there is an inability to wean the patient from the pump.
Early and correct diagnosis is lifesaving.
Coronary embolism - mitral valve replacement - surgical treatment
