Open Access

ARTICLE

Coronary Artery Complications after Right Ventricular Outflow Tract Reconstruction Surgery

by Hye Won Kwon^1,2, Mi Kyoung Song¹, Sang Yun Lee¹, Gi Beom Kim¹, Sungkyu Cho², Jae Gun Kwak², Woong-Han Kim², Whal Lee³, Eun Jung Bae^1,*

1 Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
3 Department of Radiology, Seoul National University Hospital, Seoul, South Korea

* Corresponding Author: Eun Jung Bae. Email:

Congenital Heart Disease 2022, 17(3), 281-295. https://doi.org/10.32604/chd.2022.019065

Received 01 September 2021; Accepted 20 December 2021; Issue published 03 May 2022

Abstract

Background: Mechanisms and clinical manifestations of coronary artery complications after right ventricular outflow tract reconstruction surgery are not well known. Methods: Patients who had coronary artery complications after pulmonary valve replacement or the Rastelli procedure at a single tertiary centre were retrospectively analysed. Results: Coronary artery complications were identified in 20 patients who underwent right ventricular outflow tract reconstruction surgery. The median age at diagnosis of coronary artery complication was 21 years (interquartile range: 13–25 years). Mechanisms of coronary artery complications were compression by adjacent materials in 12 patients, dynamic compression of intramural course of coronary artery in two patients, and intraoperative injury in six patients. Congenital coronary artery anomalies were identified in 50% (10/20) of patients. Four patients presented with early postoperative haemodynamic instability. Fourteen patients showed late onset symptoms or signs of coronary insufficiency, including chest pain, ventricular dysfunction, or ventricular arrhythmias. Coronary artery stenosis was incidentally found on cardiac computed tomography angiography in two asymptomatic patients. Four patients underwent surgical interventions, and one patient underwent percutaneous coronary intervention for coronary stenosis. One patient with recurrent ventricular tachycardia required an implantable cardioverter-defibrillator. There were two deaths in patients with intraoperative coronary injury. Conclusion: Preoperative coronary evaluation and long-term follow-up for the development of coronary artery complications are required in patients undergoing right ventricular outflow tract reconstruction surgery to prevent ventricular dysfunction, arrhythmias, and death, especially among those with congenital coronary anomalies.

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