Iatrogenic left main and proximal right coronary artery stenoses after aortic valve replacement

Yavuz, Şenol; Goncu, Tugrul; Sezen, Mustafa; Türk, Tamer

doi:10.1016/s1010-7940(02)00332-9

Cited by 10 publications

(4 citation statements)

References 7 publications

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“…2,4 There have been several case reports of bilateral coronary ostial stenosis after AVR, 8,12,20,[25][26][27] and also some cases treated with PCI. [8][9][10][11][12][13] We treated the present 3 cases of ICOS with PCI because the patients rejected re-operation and were willing to undergo PCI.…”

Section: Discussionmentioning

confidence: 99%

Three Cases of Iatrogenic Coronary Ostial Stenosis After Aortic Valve Replacement

Funada

Mizuno

Ohsato

et al. 2006

Circ J

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atrogenic coronary ostial stenosis (ICOS) following aortic valve replacement (AVR) is a rare but potentially lethal complication. Stenosis of the left main trunk (LMT) and ostium of the right coronary artery (RCA) after AVR was first described by Roberts and Morrow in 1967 1 and the incidence of this complication following AVR has been estimated as between 1% and 5%. [2][3][4][5][6][7] Clinical symptoms are often severe and may appear within the first 6 months. The underlying cause remains undetermined. To date, the diagnosis has been made by repeat angiography and the usual treatment has been aortocoronary bypass surgery, but recently some cases treated with balloon angioplasty and stenting (percutaneous coronary intervention (PCI)) have been reported. [8][9][10][11][12][13] We present 3 cases of ICOS treated with PCI. Case Reports Case 1A 61-year-old woman with a history of hypertension was referred because of fatigue and dyspnea on exertion. On admission the ECG showed sinus rhythm and left ventricular (LV) hypertrophy. Preoperative coronary angiography demonstrated normal coronary arteries and severe calcific aortic valve stenosis. The echo-Doppler revealed a peak aortic gradient of 90 mmHg, mild aortic regurgitation, and an aortic valve area of 0.7 cm 2 with normal LV function. We performed a modified Bentall procedure with the button technique. The patient's tricuspid valve was thickened, and extremely calcified. Coronary arteries were reconstructed with a full root technique. There was no displacement or flexion of the coronary artery graft during the surgical procedure. Myocardial protection with intermittent direct coronary cold blood cardioplegia was used. The first dose was administered by retrograde infusion from the coronary sinus (retro-cannula, RC014I, 14Fr, 4.7 mm, Edwards), and subsequently by antegrade direct cannulation of both coronary ostia using flexible, balloon-tipped cannulae (coronary perfusion cannula, Polystan). A Freestyle Prima PLUS 19-mm stentless valve (Edwards Lifesciences) was used to replace the native valve and aortic root using the full root technique. The patient made a complete recovery and was discharged on oral warfarin. Two months later she experienced severe chest pain and had a syncopal attack, and was taken to the center by ambulance. On admission the ECG showed transient ST-segment depression of 2 mm in the precordial leads, II, III, and aVF (Fig 1). Physical examination revealed normal prosthetic valve sounds, a grade 4/6 systolic ejection murmur at the right second intercostal space, and absence of rales at the base of the lungs. There was no pedal edema. Echocardiography showed normal function of the left ventricle. Repeat coronary angiography showed severe (75%) LMT stenosis and 90% stenosis of the ostium of the RCA (Fig 2). Coronary bypass surgery was recommended as the first therapeutic option, but was rejected by the patient. For this reason she was scheduled for urgent PCI. On the same day PCI of the RCA was performed using a Runway FR3.5 6F guiding catheter ...

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Section: Discussionmentioning

confidence: 99%

Three Cases of Iatrogenic Coronary Ostial Stenosis After Aortic Valve Replacement

Funada

Mizuno

Ohsato

et al. 2006

Circ J

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“…(1)(2)(3)(4) Poprvé popsali tento klinický obraz v roce 1967 Roberts a Morrow. (5) Zpravidla je postižena levá koronární tepna, (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) vzácně pravá nebo obě současně. (3,(15)(16)(17) Na rozdíl od de novo aterosklerotického postižení hraje v patogenezi roli fibromuskulární proliferace intimy jako reakce na její poškození.…”

Section: Diskuseunclassified

“…Její řešení spočívá v provedení urgentní chirurgické revaskularizace myokardu. (1,3,6,9,11,13,14) Teprve v posledních letech se objevily případy řešení pomocí PCI. (4,(7)(8)(9)12) Přes vysokou rizikovost reoperace (14) byl přístup k provedení angioplastiky nechráněného kmene spíše rezervovaný a vyhrazen pouze pro inoperabilní nemocné nebo nemocné odmítající chirurgickou revaskularizaci.…”

Section: Diskuseunclassified

Successful catheter-based management of iatrogenic left main coronary artery stenosis following aortic valve replacement

Pecková¹,

Kautzner²,

Koudelková³

et al. 2008

Cor Vasa

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Aortální stenóza, která patří mezi nejčastější získané srdeční vady, je obvykle snadno řešitelná náhradou aortální chlopně. V některých případech se může stát složitým problémem vyžadujícím opakovanou operaci nebo katetrizační intervenci. Jednou ze závažných a život ohrožujících komplikací náhrady aortální chlopně je iatrogenní ostiální stenóza (IOS) věnčitých tepen. (1-18) Jejím podkladem je fibromuskulární hyperplazie intimy jako reakce na mechanickou traumatizaci kořene aorty, odstupů věnčitých tepen (1-3,6,7,17) či podání krevní kardioplegie (3) při operaci. Tato komplikace vzniká charakteristicky během prvních týdnů po výkonu a projevuje se jako rychle progredující angina pectoris. (1,3,6,7,11) Donedávna byla jedinou léčbou časná chirurgická revaskularizace. (1,3,6,9,11,13,14) V poslední době byly popsány případy léčby iatrogenní ostiální stenózy pomocí perkutánní koronární intervence (PCI). (4,7-9,12) Cílem tohoto sdělení je popis úspěšné PCI u pacientky s IOS kmene levé věnčité tepny po opakované operaci aortální chlopně. KASUISTIKA Sedmdesátiletá pacientka s anamnézou arteriální hypertenze, dyslipidemie a polyvalentní alergie byla sledována dlouhodobě pro aortální stenózu. Pro progresi anginy pectoris do II.-III. stadia funkční klasifikace CCS (Canadian Cardiology Society) byla vyšetřena

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“…Iatrogenic left and/or right coronary artery ostial stenosis after aortic valve replacement (AVR) is a rare but life-threatening complication. The potential reasons for this problem are direct obstruction by the prosthetic annular ring or stent and trauma to the ostium during cannulation for the administration of cardioplegia [Yavuz 2002].…”

Section: Introductionmentioning

confidence: 99%

Is Percutaneous Transluminal Coronary Angioplasty the Treatment of Choice for Iatrogenic Stenosis of the Left Main Coronary Artery following Aortic Valve Replacement?

Peruga¹,

Bielecka‐Dąbrowa²,

Kasprzak³

2013

HSF

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Iatrogenic coronary ostial stenosis after aortic valve replacement (AVR) is a rare but life-threatening complication. This condition has been treated with urgent coronary bypass surgery, but such surgery is associated with high morbidity and mortality. The clinical symptoms are usually severe and may appear from 1 to 6 months postoperatively. Pains in the chest that are typical for coronary artery disease but occur in patients after the AVR operation suggest a significant threat. We report a case of left main coronary artery ostial stenosis in a patient who had normal preoperative coronary angiography results. The patient was successfully treated with implantation of a drug-eluting stent.

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Iatrogenic left main and proximal right coronary artery stenoses after aortic valve replacement

Cited by 10 publications

References 7 publications

Three Cases of Iatrogenic Coronary Ostial Stenosis After Aortic Valve Replacement

Three Cases of Iatrogenic Coronary Ostial Stenosis After Aortic Valve Replacement

Successful catheter-based management of iatrogenic left main coronary artery stenosis following aortic valve replacement

Is Percutaneous Transluminal Coronary Angioplasty the Treatment of Choice for Iatrogenic Stenosis of the Left Main Coronary Artery following Aortic Valve Replacement?

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