Coronary ostial compromise in aortic valve replacement: An avoidable complication

Farid, Shakil; Page, A.; Howell, Neil; Goddard, Martin; Abu‐Omar, Yasir; Jenkins, David P.; Nashef, Samer A.M.

doi:10.1177/0218492315573105

Cited by 12 publications

(10 citation statements)

References 13 publications

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“…The same author has suggested combined approach as it is difficult clinically to attribute symptoms to abnormal coronary or valve lesion [10]. Fareed et al have carried out a study where autopsy of all the deaths following aortic valve revealed that 3.4% of deaths were at least partly from coronary ostial compromise [11]. In this case patient undergoing aortic valve replacement, LMCA was abnormally placed.…”

Section: Discussionmentioning

confidence: 99%

Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement

Shahabuddin¹,

Sami²,

Khanv³

et al. 2018

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During aortic valve replacement, coronary artery obstruction is a rare but fatal complication. It may require revision of the surgical procedure including re-implantation of the valve or additional coronary revascularization. It is more common in the presence of abnormality of coronary artery like malposition or abnormal course. We report a case of 32 years old gentleman undergoing aortic valve replacement for severe aortic stenosis, having an abnormally placed left main coronary artery ostium. The risk of coronary ostial compression on seating the prosthetic valve was evident. A left main coronary artery unroofing was performed to translocate the ostium to avoid the obstruction. The patient recovered well intra and postoperatively and is doing well at nine months follow up.

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Section: Discussionmentioning

confidence: 99%

Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement

Shahabuddin¹,

Sami²,

Khanv³

et al. 2018

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“…Coronary artery stenosis can occur acutely after aortic valve replacement due to inadequate positioning of the valve prosthesis 4 . A postmortem autopsy report showed that 3.4% of deaths after SAVR were at least partly attributed to encroachment on one or both coronary ostia 5 with causes of ostial compromise related to the valve sutures, the valve sewing ring, and the aortotomy suture line 5 . Late coronary artery embolism following surgical aortic valve replacement is a rare event mostly related to a subtherapeutic anticoagulation leading to coronary embolic events that are treated with PCI 6,7 …”

Section: Discussionmentioning

confidence: 99%

“…4 A postmortem autopsy report showed that 3.4% of deaths after SAVR were at least partly attributed to encroachment on one or both coronary ostia 5 with causes of ostial compromise related to the valve sutures, the valve sewing ring, and the aortotomy suture line. 5 Late coronary artery embolism following surgical aortic valve replacement is a rare event mostly related to a subtherapeutic anticoagulation leading to coronary embolic events that are treated with PCI. 6,7 There are only few case reports concerning coronary stenosis as acute complication after SAVR.…”

Section: Discussionmentioning

confidence: 99%

Acute coronary occlusion after surgical replacement of the aortic valve treated with emergency off‐pump coronary artery bypass grafting

Ackah

Angelini

Bruno

2021

Journal of Cardiac Surgery

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Acute coronary occlusion after surgical replacement of the aortic valve is a rare but potentially fatal event. Due to its rarity, there is no univocal treatment with the percutaneous approach being the most commonly used for its promptness and ease of use. Only a few cases have been treated with coronary artery bypass grafting (CABG) and, to the best of our knowledge, none has been reported with the use of off-pump CABG (OPCABG). Here we describe the case of acute coronary occlusion of the circumflex artery immediately after surgical replacement of the aortic valve in a 79year-old patient. The occlusion was promptly diagnosed and treated with interval emergency balloon angioplasty followed by OPCABG of the circumflex artery. The patient made a full recovery and was discharged home 12 days after the surgery.

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“…Up to 5.5% of cases with AMI in young individuals are secondary to APS. When a stent is used in a patient with APS, the antiphospholipid antibody on intima in the stent promotes atherosclerosis, restenosis as well as vein graft disease [ 17 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

Antiphospholipid syndrome and valvular heart disease, a complex scenario of thrombotic events, a case report

Endara

Dávalos

Fierro

et al. 2020

J Cardiothorac Surg

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Background Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with thrombotic events, myocardial infarction, and valvular heart disease. During valvular replacement surgery, the high risk of thrombosis combined with the operative risks in these specific groups of patients poses a challenge to the medical team. Case presentation We present a case of a female patient with APS and mixed aortic valve disease. During surgery, she suddenly developed complete cardiac arrest. Three months later, after she recovered, and while she was still on close follow up, a thrombotic event caused myocardial infarction. After prompt and precise treatment, the patient successfully recovered; one year after surgery patient is doing well. Conclusion Adequate surgical technique along with optimal anticoagulation strategies and long term follow up are of paramount importance to ensure an uneventful recovery. A multidisciplinary team is required to manage these complex scenarios and high-risk patients.

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Coronary ostial compromise in aortic valve replacement: An avoidable complication

Cited by 12 publications

References 13 publications

Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement

Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement

Acute coronary occlusion after surgical replacement of the aortic valve treated with emergency off‐pump coronary artery bypass grafting

Antiphospholipid syndrome and valvular heart disease, a complex scenario of thrombotic events, a case report

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