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Three cases of iatrogenic coronary ostial stenosis after aortic valve replacement

Akira Funada1, Sumio Mizuno, Kazuo Ohsato

  • 1Fukui Cardiovascular Center, Shinbo, Fukui, Japan. a-funada@e-mail.jp

Circulation Journal : Official Journal of the Japanese Circulation Society
|September 26, 2006
PubMed

Insights

Iatrogenic coronary ostial stenosis (ICOS) after aortic valve replacement (AVR) is rare. Early diagnosis with multidetector computed tomography (MDCT) and treatment with percutaneous coronary intervention (PCI) are effective.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Iatrogenic coronary ostial stenosis (ICOS) is a rare but serious complication following aortic valve replacement (AVR).
  • Traditional diagnosis relies on coronary angiography, with treatment typically involving aortocoronary bypass surgery.

Observation:

  • Three cases of ICOS post-AVR presented with normal coronary arteries pre-operatively.
  • Lesions manifested within four months, showing bilateral or left main ostial stenosis.
  • Multidetector computed tomography (MDCT) aided in early detection, suggesting fibrous tissue formation.

Findings:

  • MDCT and Virtual Histology indicated fibrous tissue formation as the cause of stenosis.
  • All three patients successfully underwent percutaneous coronary intervention (PCI) with stenting.
  • One patient required elective stenting for a recurrent lesion despite being asymptomatic.

Implications:

  • Noninvasive MDCT is valuable for the early diagnosis of ICOS.
  • Percutaneous coronary intervention (PCI) offers a viable alternative treatment to bypass surgery.
  • ICOS may stem from a distinct pathological process, potentially related to fibrous tissue formation, differentiating it from atherosclerosis.
Abstract

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