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.
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.
Acute kidney injury (AKI) is associated with increased mortality and risk of chronic kidney disease (CKD). Whereas AKI is well known to occur frequently in patients with heat stroke, creatinine clearance levels of these patients have not been evaluated in literature. In this report, we present the case of a patient with increased creatinine clearance who developed AKI due to heat stroke. A 40-year-old male with no past medical history was admitted to the intensive care unit of our hospital due to AKI from heat stroke. Although he was diagnosed with stage 3 AKI at admission, his creatinine clearance, measured by a 12-h urine collection, was highly elevated to 230 mL/min/1.73 m 2 . His serum creatinine was decreased to the baseline level 12 h after admission, with fluid resuscitation. This case can suggest that creatinine clearance might be underestimated, although serum creatinine levels are elevated in AKI due to heat stroke.
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