Isolated right ventricular infarction following aortic valve replacement

Description

A woman aged 64 years, with a history of hypertension, symptomatic severe aortic stenosis and normal coronary arteries (figure 1), was submitted to aortic valve replacement with bioprosthesis Perimount Magna 21 mm and enlargement of the aortic root. Apart from atrial fibrillation, no electrocardiographic changes occurred in the postoperative period. She was discharged 7 days after surgery taking warfarin. Fifteen days later, she was readmitted in emergency department with oppressive chest pain radiating to back, hypotension, sweating and cold limbs. The 12-lead ECG showed junctional rhythm and mild ST segment elevation in V1–V3 leads, ST segment depression in inferolateral leads and an unequivocal ST segment elevation in right leads (figure 2A, B). Transthoracic echocardiogram disclosed dilation of right chambers, severe right ventricular dysfunction with akinesia of free wall and preserved left systolic function. On the blood sample, mild anaemia, hyperlactacidemia, INR 2.1 and normal values...

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