Spontaneous coronary artery dissection during cabergoline therapy

Although spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, it should be considered during the evaluation of patients who have chest pain. Coronary vasospasm can lead to spontaneous dissection. The dopamine agonist cabergoline is known to cause digital vasospasm. Herein, we report a case of spontaneous right coronary artery dissection in a 43-year-old woman who was taking cabergoline as therapy for prolactinoma. To our knowledge, this is the first report of an apparent relationship between cabergoline therapy and spontaneous coronary artery dissection. The possible association of cabergoline with coronary artery spasm and dissection should be considered in patients who present with chest pain while taking this medication.

Tricuspid anterior leaflet replacement with autologous pericardium and polytetrafluoroethylene chordae, followed by edge-to-edge repair

Treatment of endocarditis of the tricuspid valve is very complex. Valvectomy without replacement can result in significant postoperative morbidity, and replacement is hazardous due to the possibility of prosthetic infection. Repair of the tricuspid valve is the best alternative. Many ingenious methods have been devised to repair the tricuspid valve in patients with infective endocarditis. However, repair of the endocarditic anterior leaflet presents a difficult surgical problem. We have developed a technique to replace the central portion of the anterior leaflet, in which most of the leaflet is excised and replaced with autologous pericardium. By preserving a small rim of the leaflet, we preserve the lateral and medial chordal attachments. Supplemental neochordae are created with polytetrafluoroethylene sutures. An edge-to-edge repair is used to correct residual insufficiency of the valve. We have used this technique in 4 patients. One patient died 1 month after surgery, but with a competent tricuspid valve. Three patients are now alive, 48, 34, and 1.5 months after surgery. Their tricuspid valves are functional, moving well, and competent. We conclude that the centrally infected anterior leaflet of the tricuspid valve can be replaced with autologous pericardium. The implantation of polytetrafluoroethylene neochordae and edge-to-edge repair can be used to achieve valve competence. Short- and medium-term follow-up in patients who have been treated with these techniques demonstrates that the valve remains fully mobile and competent.