UNSUSPECTED DISSECTING HEMATOMA (ANEURYSM) AND RIGHT CORONARY ARTERIAL OCCLUSION FOLLOWING OPEN-HEART MITRAL VALVULOTOMY

Abstract

A dissecting hematoma (aneurysm) of the thoracic aorta below the left subclavian artery and significant occlusion of the right coronary artery were demonstrated in a woman being considered for mitral valve replacement following selective supra-aortic valvular aortography and left ventriculography. The femoral arteries had been cannulated during open-heart mitral valvulotomy 8 mo. earlier and may have been the cause of the aortic dissection since such complications have followed femoral arterial cannulation incident to open-heart surgery. Recovery following operation was stormy and had been attributed to hemothorax, shock, and cardiac arrhythmia because she had improved following blood transfusions and restoration to normal sinus rhythm. The coronary arterial occlusion and aortic dissection were not detected until they were revealed by selective aortography. Care is necessary to avoid aortic dissection during femoral arterial cannulation for open-heart surgery. Coronary arterial occlusion is also a hazard of cardiac surgery, and apparently occurs when calcific plaques or thrombus are dislodged from either the valves or heart.