Coronary ostial stenosis after coronary artery bypass graft and combined aortic valve replacement: case report.

Abstract

A 65-year-old female patient with a medical history of hypertension and dyslipidemia came to the outpatient department with a complaint of chest pain and shortness of breath. Coronary angiography was carried out in 2008, which revealed triple vessel coronary artery disease, valvular heart disease, and ostial stenosis. In 2009, the patient underwent coronary artery bypass graft surgery combined with aortic valve replacement and remained asymptomatic thereafter. In 2022, transthoracic echocardiography and a Doppler study were conducted, which revealed normal size left ventricle, an ejection fraction of 55%, and diastolic dysfunction grade I. A graft study was done, which revealed left main and right coronary artery were normal, and the left circumflex artery with mild stenosis and obtuse marginal with subtotal stenosis and severe ostial stenosis of the LAD was observed. Recognizing this complication early can prevent life-threatening complications and is then of the utmost importance. Coronary ostial stenosis is an uncommon but potentially dangerous consequence of aortic valve replacement whose etiology is not well understood in the literature. Rapid clinical identification is therefore essential. Coronary angiography needs to be done right away if coronary ostial stenosis is suspected. The mainstay of treatment for ostial stenosis is coronary artery bypass surgery or percutaneous coronary angioplasty. Since the patient has already undergone a coronary artery bypass graft (CABG) surgery, there is a significant risk of redoing CABG, as it is associated with considerable morbidity, which has a negative effect on long-term quality of life. Despite the fact that CABG is the most common form of therapy, percutaneous coronary intervention has demonstrated good short-term outcomes. To assess the effectiveness of CABG with drug-eluting stents for the treatment of coronary ostial stenosis, further information on long-term outcomes is required.