Abstract
During aortic valve replacement, coronary artery obstruction is a rare but fatal complication. It may require revision of the surgical procedure including re-implantation of the valve or additional coronary revascularization. It is more common in the presence of abnormality of coronary artery like malposition or abnormal course. We report a case of 32 years old gentleman undergoing aortic valve replacement for severe aortic stenosis, having an abnormally placed left main coronary artery ostium. The risk of coronary ostial compression on seating the prosthetic valve was evident. A left main coronary artery unroofing was performed to translocate the ostium to avoid the obstruction. The patient recovered well intra and postoperatively and is doing well at nine months follow up.
Highlights
Obstruction of coronary arteries after aortic valve replacement has been reported in the literature to have fatal outcome or reoperation [1, 2]
The exact mechanism is not known but coronary ostial obstruction in aortic valve replacements can be iatrogenic, from coronary spasm and from embolization of calcium plaque into coronary ostia leading to catstrophic events immediately or at a later stage requiring surgical or percutaneous revascularization [3, 4]
We report a case where a malposition of left main coronary artery (LMCA) during aortic valve replacement was treated by LMCA unroofing procedure
Summary
Obstruction of coronary arteries after aortic valve replacement has been reported in the literature to have fatal outcome or reoperation [1, 2]. The exact mechanism is not known but coronary ostial obstruction in aortic valve replacements can be iatrogenic, from coronary spasm and from embolization of calcium plaque into coronary ostia leading to catstrophic events immediately or at a later stage requiring surgical or percutaneous revascularization [3, 4]. The other possible mechanisms are valve to annulus mismatch or abnormal coronary ostia or their malposition predisposing to such catastrophes. We report a case where a malposition of left main coronary artery (LMCA) during aortic valve replacement was treated by LMCA unroofing procedure
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