Three Cases of Iatrogenic Coronary Ostial Stenosis After Aortic Valve Replacement

Background Iatrogenic coronary ostial stenosis (ICOS) is a rare but potentially life-threatening complication of aortic valve replacement (AVR). This complication is usually diagnosed by angiography and treated with aortocoronary bypass surgery. Case Reports In the present 3 cases pre-operative coro...

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Bibliographic Details
Published in:Circulation Journal 2006, Vol.70(10), pp.1312-1317
Main Authors: Funada, Akira, Mizuno, Sumio, Ohsato, Kazuo, Murakami, Tatsuaki, Moriuchi, Ikuo, Misawa, Katsushi, Kokado, Hiromasa, Shimada, Yoshifumi, Ishida, Kentarou, Ohashi, Hirokazu
Format: Article
Language:English
Subjects:
Aged
Angioplasty, Balloon, Coronary
Aortic Valve - surgery
Aortic valve replacement
Coronary Stenosis - etiology
Coronary Stenosis - pathology
Coronary Stenosis - surgery
Female
Heart Valve Prosthesis Implantation - adverse effects
Humans
Iatrogenic coronary ostial stenosis
Iatrogenic Disease
Male
Middle Aged
Multidetector computed tomography
Percutaneous coronary intervention
Stents
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Summary:Background Iatrogenic coronary ostial stenosis (ICOS) is a rare but potentially life-threatening complication of aortic valve replacement (AVR). This complication is usually diagnosed by angiography and treated with aortocoronary bypass surgery. Case Reports In the present 3 cases pre-operative coronary angiography confirmed normal coronary arteries and they underwent uncomplicated AVR. Coronary lesions were clinically manifest within 4 months after surgery, and repeat coronary angiography demonstrated bilateral ostial stenosis in 1 patient and left main trunk stenosis in the other 2. Two cases were detected by multidetector computed tomography (MDCT) before angiography. MDCT and Virtual Histology suggested fibrous tissue formation in the lesions. All 3 patients were successfully underwent percutaneous coronary intervention (PCI) and stenting. The post-procedure clinical course has been uneventful, except for elective stenting of a recurrent lesion in 1 asymptomatic patient. Conclusions The incidence of ICOS after AVR is low. Noninvasive MDCT is useful for early diagnosis and PCI is a possible alternative treatment. ICOS may be caused by fibrous tissue formation, and therefore be distinct from conventional atherosclerosis. (Circ J 2006; 70: 1312 - 1317)
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.70.1312