Abstract 11779: Impinged RCA: Who's the Culprit?

Abstract

Introduction: Post-sternotomy chest pain (CP) has been widely reported in literature. The etiologies include myocardial infarction, pulmonary embolism, hypersensitivity reactions to foreign material, wound infection, sternal instability and dehiscence, neuropathic pain due to intercoastal nerve damage or sternal wire fracture leading to migration. Here, we report a rare case of a young patient who presented with chronic chest pain after an atrial septal defect (ASD) repair. Case: A 28-year-old male with past medical history significant for an ASD (secundum) repair with autologous pericardial patch, hyperlipidemia, COVID-19 infection, known first degree AV block, and early repolarization changes, presented for a follow-up office visit three years after his ASD repair with complaints of typical anginal symptoms. Diagnosis: Vitals, physical exam, troponin, D-dimer and inflammatory markers were unremarkable. Chest x-ray (Figure 1A) showed sternal wires in place and no fractures of wires. EKG (Figure 1B) was unchanged. Echocardiogram showed LVEF 50% and no wall motion abnormalities. He underwent a coronary CTA which identified intermittent compression on the mid-RCA from the third bottom stainless steel sternal wire (Figure 1C), warranting removal. Treatment: He underwent explantation of all sternal wires and selective right coronary angiography (Figure 1D) was performed, which revealed intact and patent RCA without any complications. He continues to follow-up in our clinic without any CP. Conclusions: Chronic CP after any cardiac surgery remains a diagnostic dilemma and a source of anxiety for patients. We recommend comprehensive discussions with patients prior to surgery about these probable complications to alleviate the anxiety. Lastly, from research thus far, removal of sternal wires is a safe, simple, and effective procedure that should be offered to patients with persistent post-sternotomy CP after exclusion of serious complications.