title: Two rings too tight: sequential emergency PCI for hemodynamic and arrhythmic complications of mitral and tricuspid valve repair.
abstract: New intra-operative mitral regurgitation is an unusual complication of tricuspid annuloplasty and maybe ischemic in etiology as a consequence of right coronary artery distortion. We report the case of a woman in whom this was treated by mitral valve annuloplasty with ensuing hemodynamic instability and ventricular arrhythmia secondary to a new left circumflex occlusion. Injury/distortion to either of the coronary arteries running in the atrio-ventricular groove is rare, and described only several times. To our knowledge, concurrent right coronary artery and circumflex artery injury/distortion has not been reported previously.
authors.affiliation: Intervention Research Fellow, Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Niket
authors.initials: N
authors.lastname: Patel
authors.forename: Florim
authors.initials: F
authors.lastname: Cuculi
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Banning
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D011474:Prosthesis Design; D015607:Stents; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
keywords: cardiac surgery; cardiac valve annulopasty; coronary intervention; intra-operative complication; postoperative complication