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Left coronary ostial obstruction after aortic valve replacement with a supra-annular aortic valve

Kanji Matsuzaki1, Hideya Unno, Taisuke Konishi

  • 1Department of Cardiovascular Surgery, Ibaraki Seinan Medical Center Hospital, Japan.

The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|June 13, 2006
PubMed

Insights

A rare case of left coronary ostial obstruction occurred after aortic valve replacement using a Top Hat valve. This complication was diagnosed intraoperatively and successfully treated with coronary bypass surgery.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Surgery
  • Medical Device Complications

Background:

  • Aortic stenosis and regurgitation are common valvular heart diseases requiring surgical intervention.
  • Aortic valve replacement is a standard treatment, with various prosthesis designs available.
  • The Top Hat valve is designed for small aortic annuli, offering a supra-annular implantation option.

Observation:

  • A 76-year-old woman with severe aortic stenosis and regurgitation underwent aortic valve replacement.
  • A 19-mm Top Hat supra-annular aortic valve was implanted due to a small aortic annulus.
  • Intraoperative transesophageal echocardiography revealed left coronary ostial obstruction.

Findings:

  • The supra-annular placement of the Top Hat valve prosthesis was implicated in obstructing the left coronary ostium.
  • The high profile of the prosthesis in a small, non-compliant aortic root may predispose to coronary ostial interference.
  • An unplanned coronary artery bypass graft was required for successful treatment.

Implications:

  • This case highlights a potential rare complication associated with the Top Hat supra-annular aortic valve.
  • Careful patient selection and pre-operative assessment are crucial, particularly in patients with small or rigid aortic roots.
  • Further investigation into the biomechanical interaction between supra-annular valves and coronary ostia is warranted to refine surgical techniques and device design.

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