Aortic Valve as a Victim of Percutaneous Coronary Angioplasty and Stenting

Iatrogenic aortic regurgitation following percutaneous coronary intervention: Role of transesophageal echocardiography in the detection and management

“…The aortic leaflet perforations remain a rare but serious complication associated with percutaneous coronary intervention. [ 1 2 3 4 5 6 7 8 7 ] The central position of the valve makes it more likely to iatrogenic injuries during percutaneous interventions. [ 6 ] These injuries are caused by the multiple passages of stiff guidewires[ 1 5 6 ] or, protrusion of a right coronary artery ostium stent onto the valve.…”

“…[ 6 ] These injuries are caused by the multiple passages of stiff guidewires[ 1 5 6 ] or, protrusion of a right coronary artery ostium stent onto the valve. [ 2 3 4 7 ] Transient aortic regurgitations have also been reported due to excessive movement of a rigid catheter in the aorta. [ 6 ] The congenital fenestrations are located in the para-commissural area in the coaptation zone of the aortic valve leaflet and do not directly result in valve insufficiency when they are intact.…”

“…Aortic valve injury is a rare complication during percutaneous coronary intervention, with reported incidence of 0.008%-0.20%. [ 1 ] A handful of cases have been reported in the past, mostly causing acute decompensation due to injury to the aortic valve leaflets;[ 1 2 3 4 5 6 7 ] however, rarely such injury may get unnoticed in the acute phase and present as chronic aortic regurgitation. We describe a 51-year-old man with history of coronary artery stenting 2 years back was scheduled for coronary artery bypass grafting and aortic valve replacement for coronary artery disease and moderate aortic regurgitation.…”

Rare case of iatrogenic aortic valve leaflet tear following a diagnostic coronary angiogram

“…1,2,13 A less frequently reported guiding catheter-related complication is aortic leaflet injury following PCI, which remains a rare occurrence, and is typically the result of leaflet damage from coronary stents. [5][6][7][8]14 In this report, we describe the first case of an aortic leaflet tear following a diagnostic angiogram. A high index of suspicion is needed when dealing with patients with known normal aortic valve morphology and no clinical evidence of endocarditis or dissection who present with acute aortic regurgitation following an angiogram.…”

“…3,4 Only a few reports describe these rare incidents following coronary stenting procedures. [5][6][7][8] We are not aware of any previously reported case of aortic leaflet tear following a routine diagnostic angiogram where no stenting was performed. Here we report the case of a 44-year-old male patient who was scheduled for a coronary artery bypass grafting (CABG) procedure but also required an aortic valve replacement (AVR) due to moderate to severe aortic regurgitation secondary to iatrogenic aortic valve leaflet tear following a diagnostic angiogram.…”