Unstable angina early after aortic valve replacement surgery in a female patient with normal coronary arteries preoperatively – a case report

Gruber, Sybille; Ng, Choi-Keung; Schwarz, Christian; Auer, Johann

doi:10.1186/1749-8090-4-29

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…The pathophysiological mechanism causing bilateral coronary ostial stenosis in the FB remains unknown, yet several theories have been suggested: (i) local pressure necrosis and subsequent intimal proliferation due to cannulation of the coronary ostia with cardioplegia catheters 8 , 9 ; (ii) a genetic predisposition for developing ostial coronary stenosis after aortic valve replacement 10 ; (iii) turbulence in the blood flow due to aortic valve replacement invoking intimal thickening and fibrous proliferation of the ostia 8 ; and (iv) an immunological reaction towards the FB causing coronary ostial stenosis. 4 , 5 Another potential mechanism for late occurring coronary stenosis from to pseudointimal membranes could be local fibrosis induced by mechanical tension from inappropriate stretch or ‘pull’ of the coronary arteries during reimplantation.…”

Section: Discussionmentioning

confidence: 99%

Myocardial ischaemia caused by bilateral coronary ostial stenosis from pseudointimal membranes in a full root freestyle valve: a case report

Bekke

Dagnegård

Sigvardsen

et al. 2020

European Heart Journal - Case Reports

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Background Coronary artery ostial stenosis is a rare but well-known complication to aortic root replacement. The occurrence of this complication in patients with the Medtronic Freestyle bioprosthesis is poorly described. We report a case of late bilateral coronary ostial stenosis due to pseudointimal membranes within a Medtronic Freestyle bioprosthesis, resulting in acute coronary syndrome. Case summary In 2013, a 43-year-old male patient received a Medtronic Freestyle bioprosthesis as a full aortic root implantation due to endocarditis with root abscess. Preoperative coronary angiography was normal. The patient, who had no previous symptoms of coronary ischaemia, presented with severe chest pain and acute coronary syndrome in 2017. Coronary angiography and electrocardiogram-gated contrast-enhanced cardiac computed tomography showed bilateral coronary ostial stenosis. The patient was successfully treated with coronary artery bypass grafting. Intraoperative inspection revealed pseudointimal membranes covering the coronary ostia. Histology showed fibro-intimal thickening with areas of inflamed granulation tissue. Discussion Bilateral coronary ostial stenosis is a severe, potentially life-threatening condition, and a possible complication to implantation of the Medtronic Freestyle bioprosthesis as a full root. The phenomenon may occur late and should be distinguished from arteriosclerotic coronary artery disease.

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Section: Discussionmentioning

confidence: 99%

Myocardial ischaemia caused by bilateral coronary ostial stenosis from pseudointimal membranes in a full root freestyle valve: a case report

Bekke

Dagnegård

Sigvardsen

et al. 2020

European Heart Journal - Case Reports

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“…However, retrograde cardioplegia alone might not be effective in the entire myocardial protection including the right ventricle. Therefore, the best method of cardioplegia still remains unclear [ 8 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, there are several reports of PCI with stent implantation treatment in ICOS with good early and late results [ 5 – 9 ]. Despite those good results, some authors recommended that PCI should only be considered in patients who would otherwise be deemed inoperable or who refused re-operation but were willing to undergo PCI [ 12 ]. However, since most patients with ICOS have acute coronary syndrome and the risk of re-operation is increased, in our opinion, PCI with drug-eluting stent implantation (due to a lower in-stent restenosis rate) is the best treatment option [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Acute coronary syndrome as a result of left main coronary artery stenosis after aortic valve replacement. A report of three cases

Araszkiewicz¹,

Lesiak²,

Urbanowicz³

et al. 2013

pwki

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Acute coronary syndrome (ACS) as a result of iatrogenic coronary ostial stenosis (ICOS) is a rare but potentially life-threatening complication of aortic valve replacement (AVR). We present three cases of patients with ACS shortly after AVR, in whom ICOS were revealed. They refused an operation and thus they were treated with percutaneous coronary intervention. The potential pathomechanisms of ICOS and treatment options are discussed.

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“…Microinjuries, local immunological and hyperplastic reactions related to the infusion pressure of cardioplegia, and the low temperature of the cardioplegic solution administered directly to the ostia of the coronary arteries constitute other possible explanations for myocardial ischemia after AVR. However, myocardial ischemia in such cases occurs later in the postoperative period [4,5].…”

Section: Discussionmentioning

confidence: 99%

Fatal outcome of early postoperative myocardial infarction after implantation of aortic valve bioprosthesis and left internal thoracic artery anastomosis to left anterior descending coronary artery caused by closure of unchanged circumflex coronary artery

Bartczak¹,

Kula²,

Zwoliński³

et al. 2012

kitp

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Acute perioperative myocardial infarction caused by coronary artery embolization after aortic valve implantation is a rare and often fatal postoperative complication. We present a case report of a 67-year-old patient operated on for aortic valve replacement (AVR) and myocardial revascularization (LITA-LAD anastomosis). Myocardial ischemia caused by occlusion of the previously intact circumflex coronary artery occurred in the early postoperative period. Despite a successful balloon angioplasty of the closed artery in the fifth hour after the procedure, the status of the patient did not improve significantly. A decrease in progressive arterial pressure, multiple organ failure, a significant rise of myocardial necrosis markers and the lack of external pacing led to death on the second day after the operation. Acute myocardial infarction after aortic valve replacement caused by occlusion of coronary vessels by calcium debris or thrombosis is a rare postoperative complication, which may be fatal even if the patency of the vessel is promptly restored.

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Unstable angina early after aortic valve replacement surgery in a female patient with normal coronary arteries preoperatively – a case report

Abstract: Background: Angina pectoris early after aortic valve replacement surgery in patients with previously normal coronary arteries may be life threatening and has to be assessed immediately.

Cited by 3 publications

References 13 publications

Myocardial ischaemia caused by bilateral coronary ostial stenosis from pseudointimal membranes in a full root freestyle valve: a case report

Myocardial ischaemia caused by bilateral coronary ostial stenosis from pseudointimal membranes in a full root freestyle valve: a case report

Acute coronary syndrome as a result of left main coronary artery stenosis after aortic valve replacement. A report of three cases

Fatal outcome of early postoperative myocardial infarction after implantation of aortic valve bioprosthesis and left internal thoracic artery anastomosis to left anterior descending coronary artery caused by closure of unchanged circumflex coronary artery

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