Is Percutaneous Transluminal Coronary Angioplasty the Treatment of Choice for Iatrogenic Stenosis of the Left Main Coronary Artery following Aortic Valve Replacement?
DOI:
https://doi.org/10.1532/HSF98.20111169Abstract
Iatrogenic coronary ostial stenosis after aortic valve replacement (AVR) is a rare but life-threatening complication. This condition has been treated with urgent coronary bypass surgery, but such surgery is associated with high morbidity and mortality. The clinical symptoms are usually severe and may appear from 1 to 6 months postoperatively. Pains in the chest that are typical for coronary artery disease but occur in patients after the AVR operation suggest a significant threat. We report a case of left main coronary artery ostial stenosis in a patient who had normal preoperative coronary angiography results. The patient was successfully treated with implantation of a drug-eluting stent.References
Chavanon O, Carrier M, Cartier R, Hebert Y, Pellerin M, Perrault LP. 2002. Early reoperation for iatrogenic left main stenosis after aortic valve replacement: a perilous situation. Cardiovasc Surg 10:256-63.nChieffo A, Park SJ, Valgimigli M, et al. 2007. Favorable long-term outcome after drug-eluting stent implantation in nonbifurcation lesions that involve unprotected left main coronary artery: a multicenter registry. Circulation 116:158-62.nFunada A, Mizuno S, Ohsato K, et al. 2006. Three cases of iatrogenic coronary ostial stenosis after aortic valve replacement. Circ J 70:1312-17.nHadjimiltiades S, Harokopos N, Papadopoulos C, Gourassas I, Spanos P, Louridas G. 2005. Left main coronary artery stenosis after aortic valve replacement. Hellenic J Cardiol 46:306-9.nPlacci A, Balducelli M, Casanova R, Maresta A. 2005. Percutaneous treatment of the left main coronary artery ostial obstruction following aortic valve replacement. Ital Heart J 6:775-7.nSeung KB, Park DW, Kim YH, et al. 2008. Stents versus coronary-artery bypass grafting for left main coronary artery disease. N Engl J Med 358:1781-92.nTakahashi M, Watanabe G, Furuta H, Doi T, Tanaka N, Misaki T. 2000. Grafts for left main trunk lesion using "MIDCAB doughnut" on beating heart. Asian Cardiovasc Thorac Ann 8:114-11.nWinkelmann BR, Ihnken K, Beyersdorf F, et al. 1993. Left main coronary artery stenosis after aortic valve replacement: genetic disposition for accelerated arteriosclerosis after injury of the intact human coronary artery? Coron Artery Dis 4:659-67.nYavuz S, Goncu TM, Sezen M, Turk T. 2002. Iatrogenic left main and proximal right coronary artery stenosis after aortic valve replacement. Eur J Cardiothorac Surg 22:472-75.n
