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Subendocardial Infarction in Severe Bicuspid Aortic Stenosis without Coronary Stenosis Confirmed by Contrast-enhanced

Takumi Akiyama1, Yuki Okoshi2, Toshiki Takano2

  • 1Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan.

Internal Medicine (Tokyo, Japan)
|September 14, 2022
PubMed

Insights

Severe aortic stenosis can cause myocardial infarction, leading to cardiac arrest. This case highlights a circumferential subendocardial defect on CT scans, confirmed by autopsy, in a patient with severe aortic stenosis but no coronary artery stenosis.

Area of Science:

  • Cardiology
  • Radiology
  • Pathology

Background:

  • Aortic stenosis (AS) is a critical valvular heart disease.
  • Myocardial infarction (MI) is a common complication of cardiovascular diseases.

Observation:

  • A 59-year-old man with severe AS experienced cardiopulmonary arrest.
  • Coronary angiography revealed no coronary stenosis, but creatine kinase-myocardial band was elevated.
  • Echocardiography showed severe AS and global hypokinesia of thickened myocardium.

Findings:

  • Contrast-enhanced CT identified a circumferential subendocardial perfusion defect in the left ventricle.
  • Autopsy confirmed circumferential subendocardial infarction of the left ventricular myocardium.
  • This is the first reported case of CT-detected circumferential subendocardial defect correlating with autopsy-proven infarction in severe AS without coronary stenosis.

Implications:

  • CT imaging may reveal subendocardial perfusion defects in severe AS.
  • These findings suggest AS can directly lead to myocardial infarction independent of coronary artery disease.
  • This case expands understanding of AS-related cardiac complications and diagnostic imaging findings.

Keywords:
aortic valve stenosisautopsycomputed tomographymyocardial infarction

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