Anesth Pain Med.  2017 Oct;12(4):348-351. 10.17085/apm.2017.12.4.348.

Acute coronary artery obstruction after aortic valve replacement surgery and role of transesophageal echocardiography

• Jang MS
• Choi JH
• Han JH
• Choi YI
• Kim JM
• Youn HC

• KMID: 2405853
• DOI: http://doi.org/10.17085/apm.2017.12.4.348

Abstract

Acute coronary artery obstruction is a rare but fatal complication of surgical aortic valve replacement (AVR). Sudden coronary spasm, embolization of calcium plaque, and surgical factors can induce acute coronary syndrome after AVR. Here, we report a case of left main coronary ostial obstruction that occurred immediately after weaning from cardiopulmonary bypass. This case highlights the importance of coronary ostial flow patency and assessment of regional wall motion abnormalities with intraoperative transesophageal echocardiography in AVR.

Keyword

Aortic valve replacement; Echocardiography

MeSH Terms

Acute Coronary Syndrome
Aortic Valve*
Calcium
Cardiopulmonary Bypass
Coronary Vessels*
Echocardiography
Echocardiography, Transesophageal*
Spasm
Weaning
Calcium

Figure

• 

  Fig. 1 Preoperative transesophageal echocardiography (TEE) revealed intact left coronary ostium (arrow) and severe aortic stenosis with heavy calcification of the bicuspid aortic valve.

• 

  Fig. 2 (A) On coronary angiography, the arrow indicates severe left main coronary ostial stenosis resembled a reversed bird beak. (B) On coronary angiography, the arrow indicates successful stent insertion at the left main coronary ostium. A asterisk denotes the new prosthetic aortic valve.

Reference

1. Yates JD, Kirsh MM, Sodeman TM, Walton JA Jr, Brymer JF. Coronary ostial stenosis, a complication of aortic valve replacement. Circulation. 1974; 49:530–4. DOI: 10.1161/01.CIR.49.3.530. PMID: 4544298.

2. Björk V, Henze A, Szamosi A. Coronary ostial stenosis:a complication of aortic valve replacement of coronary perfusion. Scand J Thorac Cardiovasc Surg. 1976; 10:1–6. DOI: 10.3109/14017437609167761. PMID: 1273553.

3. Pillai JB, Pillay TM, Ahmad J. Coronary ostial stenosis after aortic valve replacement, revisited. Ann Thorac Surg. 2004; 78:2169–71. DOI: 10.1016/S0003-4975(03)01536-4.

4. Turillazzi E, Di Giammarco G, Neri M, Bello S, Riezzo I, Fineschi V. Coronary ostia obstruction after replacement of aortic valve prosthesis. Diagn Pathol. 2011; 6:72. DOI: 10.1186/1746-1596-6-72. PMID: 21810231. PMCID: PMC3162531.

5. Umran S, Chetty G, Sarkar PK. Acute right coronary ostial stenosis during aortic valve replacement. Int J Prev Med. 2012; 3:295–7. PMID: 22624088. PMCID: PMC3354401.

6. Ono N, Sawai T, Ishii H. Coronary ostial stenosis detected by transesophageal echocardiography after aortic valve replacement:a case report. JA Clin Rep. 2017; 3:14. DOI: 10.1186/s40981-017-0083-8.

7. Yates JD, Kirsh MM, Sodeman TM, Walton JA Jr, Brymer JF. Coronary ostial stenosis, a complication of aortic valve replacement. Circulation. 1974; 49:530–4. DOI: 10.1161/01.CIR.49.3.530. PMID: 4544298.

8. Farid S, Page A, Howell N, Goddard M, Abu-Omar Y, Jenkins DP, et al. Coronary ostial compromise in aortic valve replacement:an avoidable complication. Asian Cardiovasc Thorac Ann. 2015; 23:535–42. DOI: 10.1177/0218492315573105. PMID: 25698796.

9. Nesto RW, Kowalchuk GJ. The ischemic cascade:temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol. 1987; 59:C23. 30. DOI: 10.1016/0002-9149(87)90192-5.

10. Pifarré R, Grieco J, Sullivan HJ, Scanlon PJ, Johnson SA, Gunnar RM. Coronary embolism:surgical management. Ann Thorac Surg. 1980; 30:564–8. DOI: 10.1016/S0003-4975(10)61731-6.

11. Fajadet J, Chieffo A. Current management of left main coronary artery disease. Eur Heart J. 2012; 33:36–50b. DOI: 10.1093/eurheartj/ehr426. PMID: 22210689.

12. Bangalore S, Vlachos HA, Selzer F, Wilensky RL, Kip KE, Williams DO, et al. Percutaneous coronary intervention of moderate to severe calcified coronary lesions:insights from the National Heart, Lung, and Blood Institute Dynamic Registry. Catheter Cardiovasc Interv. 2011; 77:22–8. DOI: 10.1002/ccd.22613. PMID: 20506328. PMCID: PMC2939153.