Iatrogenic right coronary artery occlusion during minimally invasive cardiac surgery-tricuspid annuloplasty-a case report.

Although rare, right coronary artery (RCA) injury is a serious complication of tricuspid annuloplasty (TAP) and warrants close attention. We report a case of ST elevation myocardial infarction secondary to iatrogenic RCA occlusion during minimally invasive cardiac surgery (MICS). Electrocardiography (ECG) revealed ST segment elevation in lead II. Transesophageal echocardiography (TEE) revealed inferior wall hypokinesis after cardiopulmonary bypass, and coronary angiography revealed peripheral RCA occlusion. Intraoperatively, we detected an atrioventricular groove deformity during the second surgical procedure. Wall motion and ECG abnormalities showed normalization after TAP was reestablished. Vigilant monitoring using TEE and ECG is important to detect intraoperative myocardial ischemia during MICS-TAP.

Ventricular septal rupture with right hypochondrial pain mimicking acute cholecystitis.

A 67-year-old man was admitted for anterior acute ST elevation myocardial infarction (STEMI) management. He developed a severe acute right subcostal pain with normal cardiac tests. On day 5 of hospitalization, cholecystectomy was performed for suspected acute cholecystitis, but the pain intensified with hemodynamical instability. Transthoracic echocardiography revealed ventricular septal rupture (VSR). After emergency operation was performed, the pain diminished with improved hemodynamics. Right subcostal pain associated with heart disease can be referred from STEMI or liver congestion with right heart failure. VSR and right heart failure may be considered as a cause of right subcostal pain of uncertain etiology. .