Severe chronic aortic regurgitation after percutaneous coronary intervention: a case report and literature review

Abstract

Background Severe aortic regurgitation (AR) is an extremely rare complication after coronary catheterization and percutaneous coronary intervention (PCI), where most reported cases have required relatively urgent surgical intervention due to acute-onset AR and cardiac decompensation. Case summary We report a case of a 60-year-old woman that previously presented with a non-ST-elevation myocardial infarction (NSTEMI) due to an ostial right coronary artery stenosis. During the course of 2 years, she developed five recurrent NSTEMI due to in-stent thrombosis, necessitating either a new coronary stent or balloon. She developed a chronic severe AR due to a drug-eluting coronary stent protruding from the right coronary artery and underwent successful aortic valve replacement and coronary artery by-pass grafting. Discussion We performed a literature review and identified 16 reported cases of iatrogenic severe aortic regurgitation related to coronary catheterization or percutaneous coronary intervention. All patients developed an acute aortic regurgitation and, thus, we report the first case of a delayed complication caused by a protruding coronary stent. The surgical strategy is related to the extent of the damage, where smaller perforations or lacerations seems to be feasible for aortic valve repair and larger defects more often lead to aortic valve replacement. Our patient developed a fibrotic right coronary cusp which could not be used to perform a successful aortic valve repair.

Severe Aortic Regurgitation Due to Aortic Valve Injury During Percutaneous Coronary Intervention

“…In 3 of the 4 chronic cases, the presence of a stent protruding into the aorta at the coronary artery ostium was postulated to have affected the aortic valve. 3 , 4 Among the 15 acute cases, 3 were attributed to CAG procedures, with 1 report suggesting an association with aortic valve fenestration, 5 and the remaining 12 were related to PCI. Notably, in 7 of the 12 PCI-related cases, backup-type guiding catheters, such as Extra Back-Up or an Amplatz left type, were used.…”

Aortic Regurgitation After Right Coronary Cusp Injury During Percutaneous Coronary Intervention

“…The other case reports attribute the cause of acute aortic regurgitation to a perforation or laceration of one of the aortic valve cusps by the catheter or wire during attempts to access the right coronary ostium [ 1 ]. In these cases, proceduralists often require different catheters to access the right coronary artery, with a common catheter being the AR 2 [ 1 , 4 - 6 ]. Most cases, including the present, resolved this complication by the replacement of the aortic valve [ 1 , 4 - 6 ].…”

“…In these cases, proceduralists often require different catheters to access the right coronary artery, with a common catheter being the AR 2 [ 1 , 4 - 6 ]. Most cases, including the present, resolved this complication by the replacement of the aortic valve [ 1 , 4 - 6 ]. In our case, the surgery team attempted to repair the aortic valve; however, the valve continued to have significant aortic regurgitation, requiring its replacement.…”

“…Coronary angiography is a diagnostic and possible therapeutic procedure to identify blockages in the coronary arteries, commonly conducted during or after myocardial infarction. The technique consists of inserting a catheter through either the radial or femoral artery, navigating it through the aorta, and positioning it near the coronary cusps close to the aortic valve [ 1 ]. Then, the catheter is directed into either the right or left coronary artery while injecting dye to assess the presence of blockages to determine the necessary treatment.…”

Delayed aortic regurgitation after TEVAR procedure: a case report

“…Most of these cases cause acute onset aortic regurgitation, requiring urgent surgical intervention. According to a literature review of coronary angiography and PCI-induced severe aortic regurgitation in 2021 [ 13 ], A total of 15 cases have been reported so far, but most of them were acute form of severe aortic regurgitation that occurred immediately after the procedure. As in this study, the cases accompanied by laceration of the aortic valve by the catheter were only a case that occurred 24 months later and a case that occurred 8 months later.…”