Coronary Ischemia after Mitral Valve Repair

Author: Raghav Murthy, MD; Derek Williams MD; David Graham MD; Brian Bethea MD
Institution: University of Texas Southwestern/Dallas
Date Reviewed: September 2024
Learning Domain: Adult Cardiac Surgery
Learning Objective: Mitral Valve Disease, Coronary Artery Disease
PowerPoint File: Coronary Ischemia after Mitral Valve Repair

Discussion Points for Conference

• When to suspect coronary injury during valve surgery
  • Tricuspid valve  / Aortic Valve  / Mitral valve
  • Anatomic features leading to injury
• How to make diagnosis
  • Clinical “Index of Suspicion”
  • Intra op / post op  EKG
  • Troponin
  • Regional wall motion abnormalities
  • Difference between air vs mechanical injury
• Reliability of testing in early post op period
• Therapeutic options

Learning Points

• Intraoperative coronary injury must be suspected to be diagnosed
• Can occur with almost any valve replacement
• More common in reoperations
• Diagnostic criteria can be challenging for surgeon when focused on primary operation
• Early diagnosis and intervention leads to best outcomes