Intraoperative, open-heart coronary angiography in severe acute aortic valve endocarditis

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Cardiac Imaging

Background:

• Aortic valve endocarditis poses challenges for coronary artery assessment due to potential calcification.
• Coronary computed tomography angiography (CCTA) may show extensive calcification, complicating interpretation.
• Intraoperative assessment of coronary arteries is crucial in complex cardiac cases.

Observation:

• A patient with aortic valve endocarditis and severe coronary calcification on CCTA was evaluated.
• Intraoperative open-heart coronary angiography was utilized for direct visualization of the coronary arteries.
• The intraoperative angiography revealed no significant coronary stenoses despite extensive calcification.

Findings:

• Open-heart coronary angiography is a feasible technique for evaluating coronary arteries in patients with aortic valve endocarditis and severe calcification.
• The absence of significant stenoses was confirmed intraoperatively.
• Aortic valve replacement was successfully performed without the need for cardiopulmonary bypass.

Implications:

• This technique can guide surgical decisions, potentially avoiding unnecessary bypass procedures.
• Intraoperative angiography provides definitive assessment when preoperative imaging is equivocal.
• It highlights a tailored approach for managing complex aortic valve endocarditis cases.