Optical Coherence Tomography Evaluation of Extraluminal Left Circumflex Artery Compression Following Mitral Valve Replacement
Notice bibliographique
Résumé
The left circumflex artery (LCx) follows the atrioventricular groove, which causes it to curve around the posterior annulus of the mitral valve (MV), making it susceptible to injury during MV surgery. LCx injury following MV surgery is rare, with a reported incidence of approximately 0.5%.1Husain A. Alsanei A. Tahir M. et al.Left circumflex artery injury post mitral valve surgery, single center experience.J Saudi Heart Assoc. 2019; 31: 94-99Crossref PubMed Scopus (8) Google Scholar The multiple mechanisms of injury include direct injury from a suture, air embolism, and extra luminal compression. We report a case of a 34-year-old male patient with known rheumatic heart disease. He had previously undergone MV commissurotomy and tricuspid valve repair at the age of 25 years and presented to the hospital with congestive heart failure. An echocardiogram demonstrated severe tricuspid regurgitation with a severely dilated right ventricle, moderate aortic insufficiency, and moderate-severe mitral stenosis with a mitral valve area of 1.2 cm2. Following review at heart team rounds, the decision was made to offer this patient complex valve surgery. A preoperative angiogram demonstrated normal epicardial coronary arteries with a left-dominant system (Fig. 1). The patient subsequently underwent aortic valve replacement with a 21-mm On-X mechanical valve (On-X Life Technologies Inc, Austin, TX), mitral valve replacement with a size 27/29 On-X mechanical valve, and a tricuspid valve replacement with a 31-mm Edwards Mitris bioprosthetic valve (Edwards Lifesciences, Irvine, CA). While attempting to wean off pump use, the patient had significant hypotension and a transesophageal echocardiogram demonstrated a new wall motion abnormality. Therefore, the patient was brought to the cardiac catherization lab for further assessment. Coronary angiography demonstrated a haziness in the LCx (Supplemental Fig. S1), which was new compared to his preoperative angiogram. To evaluate this finding further, optical coherence tomography was performed, which demonstrated normal 3-layer vessel architecture with extraluminal compression (Video 1 , view video online; Fig. 2). The minimal lumen area within the compressed area was measured to be 2.35 mm,2 with a reference area, measured for comparison, of 7.35 mm2. Based on the optical coherence tomography findings, the patient was taken back to the operating room for emergent bypass of the obtuse marginal. Unfortunately, the patient’s postoperative course was complicated by sepsis resulting in multi-organ failure, and the patient died on postoperative day 12. The LCx injury is a rare occurrence during MV surgery. Optical coherence tomography can be used to evaluate the mechanism of injury and guide further management.Novel Teaching Point•Optical coherence tomography can be used to evaluate the mechanism of coronary injury following cardiac surgery, and guide management. The authors have no funding sources to declare.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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