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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2016, Vol. 10 Issue (3) : 351-355     DOI: 10.1007/s11684-016-0465-8
CASE REPORT |
Right coronary occlusion following transcatheter aortic valve implantation: two case reports
Gang Zhang,Jun Luo,Guo Chen()
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
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Abstract  

This paper discusses two male patients with severe aortic stenosis, whose right coronary arteries (RCA) were completely occluded during transcatheter aortic valve implantation (TAVI), leading to fatal hemodynamic disorder. Occlusions of RCA complicated by TAVI are rare. In addition, emergency cardiopulmonary bypass (CPB) played a critical role in rescuing our second patient. Both patients were admitted for “severe aortic stenosis,” and TAVIs were performed. The first patient’s blood pressure immediately dropped to 70/40 mmHg after the balloon expansion and did not increase much after the administration of aramine or fluid therapy. He did not receive emergency surgery and died after 1.5 h of resuscitation. The second patient’s blood pressure fluctuated greatly for several minutes after the valve implantation, ranging from 170/100 mmHg to 60/40 mmHg. Angiography revealed a total occlusion of RCA. Thoracic surgery with CPB was performed, and the patient survived.

Keywords aortic stenosis      transcatheter aortic valve implantation      right coronary occlusion      cardiac group     
Corresponding Authors: Guo Chen   
Just Accepted Date: 20 July 2016   Online First Date: 10 August 2016    Issue Date: 30 August 2016
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-016-0465-8     OR     http://academic.hep.com.cn/fmd/EN/Y2016/V10/I3/351
Fig.1  Preoperative coronary angiography of the first patient’s right coronary artery patency (white arrows).
Fig.2  The first patient’s ventriculography shows no blood flow in the right coronary artery (black arrow), and the left one remained open (white arrows).
Fig.3  After defibrillation and CPR, no response was observed from the radiography in the first case.
Fig.4  (A) According to the parameters of aortic annulus from the chest CT, we calculated the average diameter of aortic annulus as less than 26 mm. (Original image.) (B) In the enlarged image, the long axis of the aortic annulus was 29.4 mm, and the short axis was 21.0 mm. (Enlarged image.)
Average diameter of aortic annulus (mm) 17–20 20–23 23–26 26–29
Type of the prosthetic valve (#) 23 26 29 32
Tab.1  The manufacturer-recommended prosthetic valve according to the average diameter of the aortic annulus
Fig.5  Venus Medtech A-Valve System.
Fig.6  (A) The second patient’s coronary angiography with the right coronary artery unobstructed and expedite (white arrows) after balloon valvuloplasty and aortic valve insertion. (B) After a few minutes, coronary angiography showed no blood (black arrow) flowing into the right coronary artery.
Fig.7  The second patient’s CT images show his low ostium of RCA with distance of 11.8 mm, which increases the probability of right coronary obstruction. (A) original image; (B) enlarged image.
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