Iatrogenic left main coronary artery stenosis following aortic valve replacement

Abstract

A case of severe iatrogenic fibrous left main coronary artery stenosis following aortic valve replacement (Hall-Kaster prosthesis) is documented clinically, angiographically and histologically. Reported histological data of this rare complication of valve replacement are reviewed. The onset of ischaemic symptoms in the first six months after valve replacement is highly suggestive of iatrogenic coronary artery stenosis, and urgent coronary angiography is recommended.

Left main coronary artery bifurcation angioplasty and stenting after aortic valve replacement: a case report

“…The LMCA stenosis has been reported after catheterisation or PCI, 1,2 possibly induced by catheter tip injury. After open heart surgery like AVR, [3][4][5][6] left main coronary artery stenosis occur possibly from injury by cardioplegia cannula or placement of prosthetic valve ring. Most reported cases have been ostial in location.…”

“…It has also been reported after aortic valve replacement (AVR) [3][4][5][6][7] which involves the ostium. In such a condition repeat surgical intervention is of a very high-risk.…”

Extrinsic Left Main Compression: Review of the Literature

“…3,11 The underlying mechanism is slow neointimal and fibrous reparative vessel response to cannulation injury leading to different degrees of LM obstruction. [11][12][13] Last but not least, direct obstruction of the LM ostium may be caused also by prosthetic valve due to position/orientation, oversizing, or edematous reaction after valve implantation. [14][15][16] Nonsurgical Causes of Extrinsic LM Compression.…”

“…This differs from gradually progressing LM stenosis, which is a rare but well‐reported complication after aortic valve replacement, developing in 0.3–0.9% 3,11 . The underlying mechanism is slow neointimal and fibrous reparative vessel response to cannulation injury leading to different degrees of LM obstruction 11–13 . Last but not least, direct obstruction of the LM ostium may be caused also by prosthetic valve due to position/orientation, oversizing, or edematous reaction after valve implantation 14–16 …”

Early Reoperation for Iatrogenic Left Main Stenosis after Aortic Valve Replacement: A Perilous Situation

“…vessels [2]. Optimal myocardial preservation may be difficult to attain as attested by the high rate of MI [6] leading to a left ventricular dysfunction due to fibrosis, with a high mortality rate [1,3]. Indeed, the combination of left ventricular hypertrophy having not yet fully regressed due to the short interval after AVR [7], and the limitation of effective antegrade cardioplegia due to severe proximal coronary stenosis may lead to hypoperfusion.…”