What's That in the Aorta? A Case of Asymptomatic Dislodged Ostial Right Coronary Artery Stent That Was Noted as an Echodense Material in the Aortic Valve on Transesophageal Echocardiogram.

Abstract

A 58-year-old female with a history of coronary artery disease (CAD) with remote percutaneous intervention (PCI) to ostial right coronary artery (RCA) with a bare-metal stent represented with unstable angina. Left heart catheterization (LHC) showed 90% stenosis of the previously stented ostial RCA with a moderate disease in the circumflex and left anterior descending arteries (LAD). LHC had also demonstrated that the previously placed ostial RCA stent, 19 years ago, was dislodged with only 3-4 mm within RCA and the remainder 10-12 mm in the ascending aorta. The patient miraculously had remained largely asymptomatic of this dislodged RCA stent for many years. Subsequent transthoracic echo (TTE) showed moderate-severe mitral regurgitation (MR). Therefore, she was worked up for a possible single-vessel coronary artery bypass graft surgery (CABG) with mitral valve replacement/repair. However, on transesophageal echo (TEE), MR was noted to be moderate in severity. Also, an echodense material was noted on the right coronary cusp (RCC) of the aortic valve, which was deemed to be the dislodged RCA stent. As the MR was moderate, the patient underwent successful complex PCI of ostial RCA.