Kinking of a coronary artery as a rare complication in mitral valve replacement

Forensic Science International : Synergy
C SchymaBurkhard Madea

Abstract

We present the case of a 70-year old woman who had elective mitral and aortic valve surgery. She underwent surgery without complications for about 4h until 4 pm. Approx. 3h after surgery her condition deteriorated. 1500ml of blood were collected in the chest drainage until 11 pm. An emergency thoracotomy in the patient's bed showed a ventricular rupture. Death occurred around 11:30 pm. At autopsy, the implants of the biological mitral and aortic valves were found to be sewn tightly. There was no vascular injury and no unusual bleedings to the mediastinum. In the left ventricular wall, a rupture of 1cm and a surrounding fresh myocardial infarction area of 10cm×6cm was noted. Preparation of the coronary arteries showed moderate coronary atherossclerosis without stenosis or clots. The left circumflex coronary artery (LCX) showed a sharp, obviously stenosing kink which had been caused by the mitral valve surgery. Exsanguination due to ventricular rupture following myocardial infarction caused by implant-related "kinking" of a coronary artery, was found to be the cause of death.

References

Sep 1, 1995·The Annals of Thoracic Surgery·P M EucherJ C Schoevaerdts
Nov 1, 1994·Catheterization and Cardiovascular Diagnosis·G Gershony
Jul 16, 2008·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Hayati DenizFuat Bilgen
Jun 16, 2009·Forensic Science International : Synergy·Burkhard Madea, Johanna Preuss

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Citations

Feb 20, 2016·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Nick HiltropWalter Desmet
Jul 17, 2013·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Niket PatelAdrian P Banning
Dec 3, 2014·Circulation·Sean R WilsonCarlos E Ruiz
Feb 16, 2019·Journal of the Saudi Heart Association·Aysha HusainAli AlMasood

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