Surgically Treated Intraoperative Coronary Embolism

Abstract

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.

Key words

Coronary embolism - mitral valve replacement - surgical treatment

References

• 1 Charles R G, Epstein E J. Diagnosis of coronary embolism: a review.  Journal of the Royal Society of Medicine. 1983;  76 863-869
• 2 Wenger N K, Bauer S. Coronary embolism: review of the literature and presentation of fifteen cases.  Amer J Med. 1958;  25 549-557
• 3 Ztot S, Henry P, Fornes P, Boughalem K, Chauvaud S, Guermonprez J L. Left atrial myoxoma and coronary embolism.  Arch Mal Coeur Vaiss. 1998;  91 263-266
• 4 Bjoerk V O, Malers E. Total mitral valve replacement: late results.  J Thorac Cardiovasc Surg. 1964;  48 625-634
• 5 Greenfield L J, Gaertner R A. Coronary embolectomy following mitral valvotomy on cardiopulmonary bypass.  Ann Thorac Surg. 1965;  92 448-452
• 6 Aboumrad M H, Gyorkey F. Two cases of coronary embolism following cardiac surgery.  Arch Pathol. 1969;  88 547-548
• 7 Pifarre R, Grieco J, Sullivan H J, Scanlon P J, Johnson S A, Gunnar R M. Coronary embolism: surgical management.  Ann Thorac Surg. 1980;  30 564-568
• 8 Loisance D, Aubry P, Heulin A, di Matteo J. Embolism in a fragment of the mitral papillary muscle to the left main coronary artery. A rare complication of valve replacement.  Arch Mal Coeur Vaiss. 1979;  72 1029-1033
• 9 Yavuzgil O, Ozerkan F, Gurgun C, Zoghi M, Can L, Akin M. Exercise testing induces fatal thromboembolism from mechanical mitral valve.  Tex Heart Inst J. 2002;  29 48-50
• 10 Abid-Allah M, Al Jubair K. Acute right coronary artery embolus after aortic valve surgery.  Asian Cardiovasc Thorac Ann. 2002;  10 367-368