Iatrogenic aortic valve fenestration rupture following coronary angiography: a case report

Abstract

Background Aortic valve fenestration (AVF) is a relatively common anatomical variation, while its rupture is a rare cause of aortic regurgitation (AR), especially following coronary angiography. This case report highlights the importance of echocardiographic evaluation and multidisciplinary discussion for the differential diagnosis with fibroelastoma or endocarditis. Case Description A 66-year-old man presented with acute shortness of breath following coronary angiography for an inferior ST elevation myocardial infarction. Echocardiography revealed severe aortic regurgitation associated with a filamentous mobile structure on the non-coronary cusp. A multidisciplinary discussion was conducted to determine the cause of the AR, leading to the patient undergoing aortic valve replacement. Gross inspection of the valve confirmed AVF rupture. Conclusion Iatrogenic AVF rupture following coronary angiography is an exceptionally rare complication. Thorough echocardiographic evaluation plays a significant role in differentiating AVF rupture from other valve pathologies, such as fibroelastoma, Lambl’s excrescence or endocarditis. Echocardiographic features, including a very thin, linear and flail-like mobile lesion, the paracommissural location, frequent involvement of the non-coronary cusp, and an eccentric jet of the AR, are suggestive of AVF rupture. While medical history and clinical examination contribute to the diagnostic process, definitive diagnosis relies on surgery and anatomopathology.

Aortic Regurgitation After Right Coronary Cusp Injury During Percutaneous Coronary Intervention

“…In these cases, proceduralists often require different catheters to access the right coronary artery, with a common catheter being the AR 2 [1,[4][5][6]. Most cases, including the present, resolved this complication by the replacement of the aortic valve [1,[4][5][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.…”

“…Experiencing acute aortic regurgitation (AR) after coronary angiography or percutaneous coronary intervention (PCI) is an exceedingly rare complication with an incidence of approximately 1 in 10,000 [1]. Only four case reports of acute aortic regurgitation following coronary angiography or percutaneous coronary intervention were identified in the last five years [1,[4][5][6]. 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].…”

“…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][5][6]. Most cases, including the present, resolved this complication by the replacement of the aortic valve [1,[4][5][6].…”