Post-operative External Compression of the Right Coronary Artery Following Triple Valve Surgery

We describe a 66-year-old male with right ventricular dysfunction, elevated troponins, and ST segment changes on electrocardiogram following a triple valve repair. Coronary angiography revealed a discrete right coronary artery stenosis that was refractory to multiple angioplasty attempts. Intravascular ultrasound showed no signs of intraluminal plaque or thrombosis. Recognizing the possibility of an external compressive process, the patient’s chest tubes were removed, successfully resolving the stenosis. This case emphasizes the importance of thoughtful placement of any temporary material around the heart and the need for a high index of suspicion for external compression on native coronary anatomy.