Left main coronary artery occlusion after percutaneous aortic valve implantation
Antonio L Bartorelli1, Daniele Andreini, Erminio Sisillo
1Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy. antonio.bartorelli@ccfm.it
Insights
Left main coronary artery occlusion after aortic valve implantation is a rare but serious complication. Prompt diagnosis via echocardiography and treatment with stenting led to successful recovery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transfemoral aortic valve implantation (TAVI) is a minimally invasive procedure for aortic stenosis.
- Complications, though rare, can occur during or immediately after TAVI.
- Left main coronary artery (LMCA) occlusion is a life-threatening event potentially leading to ventricular fibrillation and hemodynamic collapse.
Observation:
- An 87-year-old woman experienced immediate LMCA occlusion post-TAVI.
- Transesophageal echocardiography revealed absent diastolic LMCA jet flow.
- Aortic root angiography confirmed the occlusion.
Findings:
- The patient developed ventricular fibrillation and hemodynamic collapse.
- Prompt defibrillation and hemodynamic support with intra-aortic balloon pump and inotropes were initiated.
- Coronary stenting successfully restored LMCA patency and function.
Implications:
- Highlights the critical need for rapid diagnosis and intervention in LMCA occlusion post-TAVI.
- Emphasizes the importance of a multidisciplinary team approach for complex cardiac interventions.
- Underscores the effectiveness of coronary stenting in managing this rare complication.
Abstract:
Left main coronary artery occlusion occurred immediately after transfemoral aortic valve implantation in an 87-year-old woman, which resulted in ventricular fibrillation and hemodynamic collapse. This life-threatening complication was promptly diagnosed with transesophageal echocardiography, which showed the disappearance of diastolic left main coronary artery jet flow and was confirmed with aortic root angiography. After prompt defibrillation, hemodynamic support was obtained with intra-aortic balloon pump and inotropic drugs. Functional recovery and survival were achieved with coronary stenting. This report highlights the importance of an integrated team approach of highly skilled specialists for these novel interventions.
