Transient occlusion of the right coronary artery by a calcific bicuspid aortic valve mass – An interesting case of inferior STEMI

Abstract

Bicuspid aortic valve is one of the most common types of congenital heart defects. It affects approximately 1% of the population. Complications include aortic stenosis, dilation, and dissection. Aortic valve calcification affects both bi-and trileaflet valves. Whilst previously thought to be a ''wear and tear'' phenomenon, it is now recognized to be an active inflammatory process with T cell and macrophage infiltration [1]. A much rarer phenomenon, however, is myocardial infarction secondary to embolization from a calcific valve. A Pubmed search revealed only 9 case reports of this problem [2-10]. Mansur et al. outlined the case of a 38-year old with calcific aortic stenosis who suffered a myocardial infarction [3]. Coronary angiography revealed a distal branch obstruction of the left circumflex coronary artery. The authors hypothesized that this obstruction was secondary to calcific embolization and indeed this seems to be the commonest cause of myocardial infarction from a calcific valve. More recently, Dauvergne et al. outlined the case of a 50-year-old woman with known severe calcified bicuspid aortic stenosis, who suffered an anterolateral ST-elevation myocardial infarction following coronary angiography. A repeat angiogram demonstrated an occluded mid left anterior descending artery. Thrombectomy was performed with white-gray hard material extracted. Subsequent histology confirmed ''amorphous calcified material. .. consistent with embolized valvular tissue''. A transesophageal echocardiogram demonstrated a heavily calcified bicuspid aortic valve with a mobile lesion on the left aortic leaflet. The patient thereafter underwent a successful aortic valve replacement [10]. Only one case report has documented a calcified lesion attached to the aortic valve, causing infarction due to prolapse into the left main coronary artery [6]. Case report We present the case of a 62-year-old man who was admitted with severe central chest pain with nausea and diaphoresis. His

A rare cause of acute ST-elevation myocardial infarction: a case of coronary embolism secondary to calcified bicuspid aortic valve

“…The reported prevalence varies according to angiographic or autopsy studies ranging between 4% and 13% 6,7 . This pathological phenomenon is a recognised distinct mechanism for acute total occlusion The risk of calcifi c embolisation from aortic stenosis is recognised and can affect cerebral, renal, coronary and retinal circulation 9 and thought to be more common with bicuspid valves and severe stenotic disease due to turbulent fl ow through the diseased valve and calcium debris rupture 10,11 . In this case the coronary embolus caused clinically signifi cant anteroseptal myocardial infarction as evidenced by extensive late gadolinium enhancement in the affected coronary territory.…”

Inferior ST-Elevation Myocardial Infarction Secondary to Aortic Mass: A Rare Case Report

“…This introduction sets the stage for exploring the nuanced intricacies of how an aortic mass can contribute to myocardial infarction, shaping discussions around diagnosis, treatment modalities, and the broader implications for patient care (3,4). As medical understanding advances, delving into specific instances like Inferior STEMI associated with aortic masses becomes pivotal, offering valuable insights into refining clinical strategies and enhancing outcomes for individuals facing this intricate amalgamation of cardiac and vascular disorders (5).…”

Aortic Aneurysm Mimicking Inferior ST-Elevation Myocardial Infarction: A Case Report

“… 3 , 4 As medical understanding advances, delving into specific instances like Inferior STEMI associated with aortic masses becomes pivotal, offering valuable insights into refining clinical strategies and enhancing outcomes for individuals facing this challenging combination of cardiac and vascular disorders. 5 …”