Coronary stenting for iatrogenic stenosis of the left main coronary artery post-aortic valve replacement: an alternative treatment?

Raja, Yogesh; Routledge, Helen; Doshi, Sagar N.

doi:10.1016/j.ejcts.2010.07.001

Cited by 9 publications

(9 citation statements)

References 8 publications

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“…We present a patient with ischemia in the LAD distribution secondary to coronary steal from a large LIMA side branch that was successfully treated using the Embolization Coil-IMWCE-3-PDA5. The diagnosis and treatment of coronary steal after LIMA bypass surgery remains controversial [Raja 2011]. Advocates for occlusion of LIMA side branches in the setting of LAD ischemia indicate that anginal symptoms often improve and that objective measures of LAD ischemia frequently resolve.…”

Section: Discussionmentioning

confidence: 99%

The Unligated Left Internal Mammary Artery Side Branch as the Cause of Angina after Coronary Artery Bypass Grafting

Peruga

Bielecka‐Dąbrowa²,

Kasprzak³

2012

HSF

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The left internal mammary artery (LIMA) is a widely used conduit during coronary artery bypass graft (CABG) surgery because of its excellent long-term patency. Although large LIMA side branches are typically ligated during the surgery, the occurrence of a coronary steal phenomenon related to these side branches following surgery remains controversial. Advocates for occlusion of LIMA side branches in the setting of left anterior descending artery (LAD) ischemia indicate that anginal symptoms often improve and that objective measures of LAD ischemia frequently resolve. We present a patient with ischemia in the LAD distribution secondary to coronary steal from a large LIMA side branch that was successfully treated using the Embolization Coil-IMWCE-3-PDA5 (Cook Medical, Bjaeverskov, Denmark).

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Section: Discussionmentioning

confidence: 99%

The Unligated Left Internal Mammary Artery Side Branch as the Cause of Angina after Coronary Artery Bypass Grafting

Peruga

Bielecka‐Dąbrowa²,

Kasprzak³

2012

HSF

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“…Balloon coronary angioplasty and stent implantation are the quickest methods of restoring the flow in the occluded coronary artery either in the left main or proximal segment [9,10]. However, it should be emphasized that this method is not successful in every case.…”

Section: Discussionmentioning

confidence: 99%

Fatal outcome of early postoperative myocardial infarction after implantation of aortic valve bioprosthesis and left internal thoracic artery anastomosis to left anterior descending coronary artery caused by closure of unchanged circumflex coronary artery

Bartczak¹,

Kula²,

Zwoliński³

et al. 2012

kitp

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Acute perioperative myocardial infarction caused by coronary artery embolization after aortic valve implantation is a rare and often fatal postoperative complication. We present a case report of a 67-year-old patient operated on for aortic valve replacement (AVR) and myocardial revascularization (LITA-LAD anastomosis). Myocardial ischemia caused by occlusion of the previously intact circumflex coronary artery occurred in the early postoperative period. Despite a successful balloon angioplasty of the closed artery in the fifth hour after the procedure, the status of the patient did not improve significantly. A decrease in progressive arterial pressure, multiple organ failure, a significant rise of myocardial necrosis markers and the lack of external pacing led to death on the second day after the operation. Acute myocardial infarction after aortic valve replacement caused by occlusion of coronary vessels by calcium debris or thrombosis is a rare postoperative complication, which may be fatal even if the patency of the vessel is promptly restored.

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“…Rapid venting of the left ventricle through a vent catheter or squeezing of the left ventricle during the delivery of cardioplegic solution can be an effective option. Direct coronary ostial cannulation is also possible, but it may result in late coronary ostial stenosis [ 3 ]. Retrograde coronary sinus perfusion of cardioplegic solution may be a promising technique in the presence of significant AR; however, concerns about the efficacy and the safety of this technique with regard to the protection of the right ventricle and the posterior ventricular septum have limited its use [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis

Lee

Jeong

Sung

et al. 2015

Korean J Thorac Cardiovasc Surg

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BackgroundHypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis.MethodsThis retrospective study included 225 consecutive patients (mean age, 65±10 years; 123 males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary artery disease, an ejection fraction <50%, more than mild aortic regurgitation, or endocarditis. The patients were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia; group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution; and group C, treated with retrograde cold blood cardioplegia.ResultsGroup A contained 70 patients (31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups showed significant differences with regard to the proportion of patients with a New York Heart Association functional classification ≥III (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left ventricular dimensions (p<0.001), left ventricular mass index (p<0.001), and right ventricular systolic pressure (p<0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the three groups were not statistically significant. During postoperative recovery, no significant differences were found regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred. Similarly, no significant differences were found in long-term outcomes.ConclusionAlthough the three groups showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved with combined antegrade and retrograde cold blood cardioplegia.

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Coronary stenting for iatrogenic stenosis of the left main coronary artery post-aortic valve replacement: an alternative treatment?

Cited by 9 publications

References 8 publications

The Unligated Left Internal Mammary Artery Side Branch as the Cause of Angina after Coronary Artery Bypass Grafting

The Unligated Left Internal Mammary Artery Side Branch as the Cause of Angina after Coronary Artery Bypass Grafting

Fatal outcome of early postoperative myocardial infarction after implantation of aortic valve bioprosthesis and left internal thoracic artery anastomosis to left anterior descending coronary artery caused by closure of unchanged circumflex coronary artery

Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis

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