An unusual case of cardiogenic shock late following surgical aortic valve replacement

The present case describes a rare but potentially life-threatening complication following surgical aortic valve replacement (AVR): iatrogenic coronary ostial stenosis (ICOS). The incidence of ICOS is estimated to be between 0.3% and 5% of all AVR and it generally occurs within 6 months after the procedure. In most cases, either the left main stem or the ostium of the right coronary artery (RCA) is affected, although stenosis of the ostium of the left anterior descending artery can also occur. However, to the best of our knowledge, the simultaneous involvement of both coronary ostia, presenting with rapid onset cardiogenic shock requiring inotropic support and intra-aortic balloon pump placement, has never been reported. <Learning objective: Iatrogenic coronary ostial stenosis (ICOS) is a rare but possible complication that can occur after aortic valve replacement. When ICOS is suspected, especially in unstable patients, a prompt diagnosis and early revascularization therapy is crucial. In this clinical setting, coronary percutaneous coronary intervention appears to be the best revascularization option.>.