title: Direct injury to right coronary artery in patients undergoing tricuspid annuloplasty.
abstract: BACKGROUND
  Direct injury to the right coronary artery as a result of reparative operation on the tricuspid valve is a rare, probably underdiagnosed, but serious complication, which often involves dramatic clinical consequences. So far, only five cases have been described in the literature.
  
  
  METHODS
  We describe our single-center experience of this complication, and review and analyze relevant clinical and anatomic considerations related to this entity. Cases previously reported in the literature were also reviewed.
  
  
  RESULTS
  We describe four cases of direct injury to the right coronary artery in patients undergoing tricuspid annuloplasty (DeVega annuloplasty, 3; ring annuloplasty, 1) in our institution since 2005. All patients had right ventricular dilatation and severely dilated tricuspid annulus. Right coronary artery occlusion always occurred between the right marginal artery and the crux of the heart. Patients presented with hemodynamic or electrical instability. Coronary flow could be restored in 2 patients (percutaneously 1; surgically 1), both of whom finally survived, while it was not technically possible in the other 2 (1 died).
  
  
  CONCLUSIONS
  Occlusion of the right coronary artery in patients undergoing tricuspid annuloplasty is a rare complication that may occur if great annulus dilatation is present, thus altering both normal annular geometry and the relationship between the right coronary artery and the tricuspid annulus, particularly when DeVega annuloplasty is performed. Such an entity should be considered in the immediate postoperative period in an unstable patient, especially when complementary tests support this diagnosis. Prompt recognition and treatment can positively affect the patient's outcome, most often by means of an emergency revascularization strategy.
authors: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. Electronic address: pablo_diez_villanueva@hotmail.com.
authors: Pablo
authors: P
authors: Díez-Villanueva
authors: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
authors: Enrique
authors: E
authors: Gutiérrez-Ibañes
authors: Departments of Cardiovascular Surgery and Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Gregorio P
authors: GP
authors: Cuerpo-Caballero
authors: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
authors: Ricardo
authors: R
authors: Sanz-Ruiz
authors: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
authors: Manuel
authors: M
authors: Abeytua
authors: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
authors: Javier
authors: J
authors: Soriano
authors: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
authors: Fernando
authors: F
authors: Sarnago
authors: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
authors: Jaime
authors: J
authors: Elízaga
authors: Departments of Cardiovascular Surgery and Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Angel
authors: A
authors: González-Pinto
authors: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
authors: Francisco
authors: F
authors: Fernández-Avilés
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D014261:Tricuspid Valve / Q000601:surgery*