title: Iatrogenic right coronary artery stenosis resulting from surgical tricuspid valve replacement: case report and review of the literature.
abstract: Iatrogenic injury to the right coronary artery (RCA) is a rare complication of tricuspid valve surgery. We herein describe the first-ever report of RCA injury related to tricuspid valve replacement surgery. A 38-year-old man with recurrent tricuspid endocarditis underwent redo tricuspid valve replacement by means of a minimally invasive right thoracotomy with a 32-mm St. Jude bioprosthetic valve. His post-operative course was complicated by pulseless ventricular tachycardia requiring CPR and defibrillation. Cardiac catheterization revealed a "kinked" stenotic distal RCA. The lesion was noted to be flow limiting by fractional flow reserve and was treated with two everolimus-eluting stents. The RCA runs in the atrioventricular groove and is susceptible to injury especially in the region of the posterior leaflet of the tricuspid valve, where the relationship of the tricuspid annulus to the RCA is most intimate. Repair of surgically induced coronary stenosis can be accomplished with percutaneous intervention.
authors.affiliation: Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Morrissy
authors.forename: Broadus Zane
authors.initials: BZ
authors.lastname: Atkins
authors.forename: Jason H
authors.initials: JH
authors.lastname: Rogers
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000209:etiology*; D004452:Echocardiography; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*
keywords: arterial occlusive diseases/etiology; coronary vessels/injuries; heart valve prosthesis implantation/adverse effects; intraoperative complications; percutaneous coronary intervention/PCI; tricuspid valve replacement/surgery