An Unusual Case of Epicardial Coronary Artery Compression

Document Type

Article

Publication Title

Journal of the American College of Cardiology

Abstract

Atherosclerotic plaque rupture, embolization, or dissection are the common causes of acute coronary artery occlusion. We present a case of iatrogenic external compression of the right-sided posterior descending artery (rPDA) by a chest tube.

Case

A 74-year-old patient with severe aortic stenosis underwent surgical aortic valve replacement (SAVR). Preoperative coronary angiogram showed normal epicardial coronary arteries as well as normal ventricular wall motion. Postoperatively patient developed chest pain. EKG showed inferior wall ischemia with new inferior wall motion abnormality in Echocardiogram. Patient underwent repeat coronary angiogram which showed patient had obstruction of rPDA by chest tube placed for post-op drainage. Pain was resolved after withdrawal of the chest tube. Decision-making

Iatrogenic external compression of a coronary artery is a rare cause of acute myocardial ischemia. Myocardial ischemia after SAVR is more than other valve surgery due to global ischemia of increased LV mass after aortic cross-clamping. There are other causes of ischemia including coronary artery embolization, trauma, or spasm. In our case iatrogenic coronary artery compression by chest tube causing symptoms, EKG, and echocardiographic changes.

Conclusion

Post cardiac surgery myocardial ischemia has multiple causes. Keeping iatrogenic external compression in the differential would help prompt recognition and management.

DOI

https://doi.org/10.1016/S0735-1097(23)04406-

Publication Date

3-7-2013

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