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J Thorac Cardiovasc Surg 2006;131:239-240
© 2006 The American Association for Thoracic Surgery

Brief Communication

Management of new-onset mitral regurgitation with intraoperative angiography and intraoperative percutaneous coronary intervention

James P. Greelish, MD a , Susan S. Eagle, MD c , David X. Zhao, MD b , Robert J. Deegan, MD c , Marshall H. Crenshaw, MD b , Jorge M. Balaguer, MD a , Rashid M. Ahmad, MD a , John G. Byrne, MD a , *

a Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn
b Department of Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tenn
c Department of Anesthesia, Vanderbilt University Medical Center, Nashville, Tenn

Received for publication August 29, 2005; accepted for publication August 31, 2005.

* Address for reprints: John G. Byrne, MD, Department of Cardiac Surgery, Vanderbilt University Medical Center, 2311 Pierce Ave, Room 2400, Nashville, TN 37232-8815 (Email: john.byrne@vanderbilt.edu).

The first 20% of the full text of this article appears below.

New-onset mitral regurgitation after routine coronary revascularization is most often the result of ischemia and may be secondary to acute graft dysfunction. After securing the diagnosis, the surgeon must speculate as to the cause (eg, myocardial stunning, subendocardial ischemia, poor myocardial protection, or thrombosis, kinking, or anastomotic obstruction of the graft). Currently available intraoperative diagnostic tools include transesophageal echocardiography, flow meters, and manual palpation of grafts, all of which are limited. Surgical graft revision invariably requires a second period of cardiopulmonary bypass and aortic crossclamping. We describe a patient in whom new-onset severe mitral regurgitation was diagnosed by intraoperative echocardiography in our new "hybrid" operating suite. In this environment, a combined catheterization laboratory and operating room, and the use of intraoperative completion angiography, . . . [Full Text of this Article]






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