Suture-induced right coronary artery stenosis.

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Radiology

Background:

• Surgical aortic valve replacement (SAVR) is a common procedure for aortic valve disease.
• Complications following SAVR can impact coronary artery perfusion.
• Right heart failure is a potential, though uncommon, post-operative complication.

Observation:

• An 82-year-old patient presented with right heart failure post-SAVR.
• Coronary CT angiography revealed high-grade stenosis in the mid-right coronary artery.
• Noncontrast CT identified adjacent suture material near the stenosis, suggesting a surgical cause.

Findings:

• Invasive angiography confirmed significant stenosis of the right coronary artery.
• The stenosis was strongly suspected to be iatrogenic, related to the right atrial cannulation site closure during surgery.
• Successful percutaneous coronary intervention (PCI) was performed to restore blood flow.

Implications:

• This case highlights a rare but serious complication of SAVR.
• Early diagnosis using advanced imaging like CT angiography is crucial for timely intervention.
• Percutaneous intervention offers an effective treatment option for this specific type of coronary stenosis.