Pablo Díez-Villanueva, MD, Enrique Gutiérrez-Ibañes, MD, Gregorio P

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Direct Injury to Right Coronary Artery in Patients Undergoing Tricuspid Annuloplasty Pablo Díez-Villanueva, MD, Enrique Gutiérrez-Ibañes, MD, Gregorio P. Cuerpo-Caballero, MD, Ricardo Sanz-Ruiz, MD, Manuel Abeytua, MD, Javier Soriano, MD, Fernando Sarnago, MD, Jaime Elízaga, MD, PhD, Angel González-Pinto, MD, PhD, Francisco Fernández-Avilés, MD, PhD The Annals of Thoracic Surgery Volume 97, Issue 4, Pages 1300-1305 (April 2014) DOI: 10.1016/j.athoracsur.2013.12.021 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Coronary angiograms of our 4 patients (cases 1 to 4), showing right coronary artery occlusion occurring between the right marginal artery and the crux of the heart in all cases. The Annals of Thoracic Surgery 2014 97, 1300-1305DOI: (10.1016/j.athoracsur.2013.12.021) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Relationship between the right coronary artery and tricuspid valve. The segment delimited by the right marginal artery and the crux is the most closely related to the tricuspid annulus (between the anteroposterior commissure and posterior leaflet). The Annals of Thoracic Surgery 2014 97, 1300-1305DOI: (10.1016/j.athoracsur.2013.12.021) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Relationship between the right coronary artery and tricuspid valve. The segment delimited by the right marginal artery and the crux is the most closely related to the tricuspid annulus (between the anteroposterior commissure and posterior leaflet). The Annals of Thoracic Surgery 2014 97, 1300-1305DOI: (10.1016/j.athoracsur.2013.12.021) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Proposed diagnostic and therapeutic algorithm in case of right coronary artery (RCA) injury in tricuspid annuloplasty (TA). * Other causes of instability: prior RV or LV dysfunction, volume overload, pulmonary hypertension, myocardial stunning caused by extracorporeal circulation, air emboli and electrolyte disturbances. The Annals of Thoracic Surgery 2014 97, 1300-1305DOI: (10.1016/j.athoracsur.2013.12.021) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions