Acute right ventricular failure during aortic valvular operation due to mechanical problem in the right coronary artery.

BACKGROUND

When right ventricular failure occurs during aortic valvular operation, inadequate myocardial protection may be the culprit. However, other causes of right ventricular failure should be considered, such as air or particulate matter embolization. Right ventricular failure unexpectedly occurred during an aortic valvular operation, and the cause was found to be a mechanical problem with the right coronary ostium.

METHODS

A mechanical problem with the right coronary artery (RCA) occurred in 9 patients undergoing aortic valvular procedures, which included isolated aortic valve replacement (4 patients), aortic valve replacement and coronary artery bypass (1 patient), Bentall procedure (2 patients), aortic valve reconstruction (1 patient), and double valve replacement and coronary artery bypass (1 patient). Although myocardial protection was considered to be the cause, a mechanical problem was subsequently identified in the RCA, leading that artery to be bypassed with a segment of saphenous vein.

RESULTS

The 1 patient in whom the condition was not recognized at time of aortic valve operation died; at autopsy, a damaged and occluded right ostium was confirmed. The other 8 patients who had the RCA bypassed survived.

CONCLUSIONS

We conclude that when right ventricular failure unexpectedly occurs during an aortic valvular operation and does not improve with reperfusion, a mechanical problem in the RCA should be considered. In this situation we recommend that the RCA be bypassed with a segment of saphenous vein graft.