Acute coronary syndrome as a result of left main coronary artery stenosis after aortic valve replacement. A report of three cases

Abstract

Acute coronary syndrome (ACS) as a result of iatrogenic coronary ostial stenosis (ICOS) is a rare but potentially life-threatening complication of aortic valve replacement (AVR). We present three cases of patients with ACS shortly after AVR, in whom ICOS were revealed. They refused an operation and thus they were treated with percutaneous coronary intervention. The potential pathomechanisms of ICOS and treatment options are discussed.

Delayed Coronary Ostial Stenosis after Surgical Aortic Valve Replacement and Root Enlargement Treated with Beating Heart On-Pump CABG

“…Clinical presentation includes symptoms of stable angina, acute coronary syndrome, ventricular arrhythmia, congestive heart failure, and sudden cardiac death, which typically appear either 1 to 6 months postoperatively or immediate perioperative. It has rarely have been identified within the first 4 weeks or beyond 1 year after surgery [1] [3].…”

“…In the era of LM stenting, several case reports of successful ICOS treatment with PCI (thrombus aspiration or angioplasty/drug-eluting stents) have been published with excellent short and midterm outcomes [3]. The major advantages are immediate availability and lower procedural risk but it is not suitable for all.…”

“…The estimated incidence is about 0.3% -3.4% [1]. It can occur in one or both coronary Ostia, more commonly affect the left main coronary artery (LM) compared to the right coronary artery (RCA) [2] [3]. Clinical presentation is typical with symptoms of acute myocardial ischemia, ventricular arrhythmia, or heart failure.…”