A 73-year-old man with severe aortic stenosis and severe coronary artery disease of the anterior descending artery (LAD) and right coronary artery (RCA) underwent surgery, which included implantation of a number 21 St. Jude Trifecta aortic bioprosthesis ( Saint Jude Inc, United States) and surgical revascularization of the internal mammary artery to the LAD (IMA-DA) and of the saphenous vein to the CD (SV-CD). One month after surgery he presented to the outpatient clinic complaining of progressive exertional angina.
The transthoracic echocardiogram showed a normally functioning aortic valve bioprosthesis. Coronary angiography revealed the previously known native coronary artery disease and a patent LAD-IMA graft, but the SV graft was not connected to the distal RCA, instead filling the coronary venous sinus (Figure 1 and Video 1 in the Supplementary Material). Cardiac computed tomography confirmed the connection between the SV graft and the middle cardiac vein, which ultimately drains into the coronary sinus (Figure 2). The RCA was revascularized percutaneously with the implantation of one drug-eluting stent , and it was decided in a joint surgery session to close the SV graft with the implantation of a 6 × 12 mm AVP4 stent (Abbot, USA), which was successfully performed (Figure 3 and Video 2 in the Supplementary Material). The patient's angina was relieved after percutaneous revascularization and right heart chamber dilation was prevented by closure of the VS graft.
It is important to recognize surgical coronary complications and provide alternative solutions. This promotes collaboration between clinical cardiology, interventional cardiology and cardiovascular surgery.
By doctors Ricardo Mori, Daniele Gemma, Ana Casado, Frank Sliwinsky, Angélica Romero and Jorge Palazuelos*
* Corresponding author.
(J. Palazuelos) @rmori11
Received on October 12, 2022. Accepted on November 3, 2022.
Full English text available from: https://www.recintervcardiol.org/en.
2604-7306 / © 2022 Spanish Society of Cardiology. Published by Permanyer Publications. This is an open access article under the CC BY-NC-ND 4.0 license.
All procedures were performed in accordance with the ethical standards of the institutional and national research committee as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from the patient.
ADDITIONAL MATERIAL
Additional material to this article can be consulted in its electronic version available at
https://doi.org/10.24875/RECIC. M22000349.
CONTRIBUTION OF THE AUTHORS
R. Mori: collection of data and figures, writing of the original draft. D. Gemma: collection of data and figures, writing of the original draft. A. Married: edition of the original draft. F. Sliwinsky: edition of the original draft. A. Romero: collection of data and figures, editing of the original draft. J. Palazuelos: conceptualization, supervision, review and editing.
CONFLICT OF INTERESTS
Any.