Suspected coronary ostium calcification identified as a protruding stent by epiaortic echography

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Diagnostic Imaging

Background:

• A 76-year-old male presented for mitral valvuloplasty with a history of myocardial infarction and coronary artery stenting.
• Intraoperative transesophageal echocardiography identified a suspicious echogenic mass at the left main coronary artery ostium.

Observation:

• The mass, measuring 10x8 mm, was initially suspected to be severe atheromatous calcification requiring aortotomy.
• An epiaortic ultrasonographic scan was performed for better imaging and reevaluation of the coronary ostium lesion.

Findings:

• Epiaortic scanning definitively identified the echogenic mass as a protruding coronary stent.
• This finding altered the initial diagnostic suspicion and planned surgical approach.

Implications:

• Highlights the importance of advanced imaging techniques like epiaortic ultrasonography in complex cardiac cases.
• Demonstrates the potential for implanted devices to present as unexpected findings during cardiac procedures.
• Emphasizes the need for accurate pre-procedural diagnosis to guide appropriate surgical or interventional strategies.