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Nazir SA, Sarfraz S, Krishnamoorthy S, Tapp L. Biostial iatrogenic coronary artery stenosis: a rare complication of aortic valve surgery successfully treated with percutaneous coronary stenting. Interact Cardiovasc Thorac Surg 2019; 28:996-998. [PMID: 30698782 DOI: 10.1093/icvts/ivy359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/13/2018] [Accepted: 12/10/2018] [Indexed: 11/14/2022] Open
Abstract
A 66-year-old woman presented 4 months after conventional surgical aortic valve replacement with an acute coronary syndrome resulting from rare iatrogenic biostial left main and right coronary artery stenoses, which were successfully treated with percutaneous coronary stenting, optimized by intracoronary imaging.
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Affiliation(s)
- Sheraz A Nazir
- Cardiac & Respiratory Department, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Suresh Krishnamoorthy
- Cardiac & Respiratory Department, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Luke Tapp
- Cardiac & Respiratory Department, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
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2
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Alqahtani F, Ziada K, Rihal CS, Alkhouli M. Incidence and outcomes of early percutaneous coronary intervention after isolated valve surgery. Catheter Cardiovasc Interv 2018; 93:583-589. [PMID: 30269409 DOI: 10.1002/ccd.27874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Coronary ischemia requiring early percutaneous coronary intervention (PCI) is a rare but serious complication of isolated valve surgery. We sought of assess the incidence, predictors and outcomes of early PCI after isolated valve surgery using the national inpatient sample. METHODS Patients who underwent isolated aortic valve replacement (AVR), isolated mitral valve repair (MVr) or replacement (MVR) between 2003 and 2014 were identified. Patients who had early postoperative PCI were compared with patients who did not require PCI. Primary end point was in-hospital mortality. Secondary endpoints were complications, length-of-stay and cost. RESULTS Among the 135,611 included patients, 1,074 (0.8%) underwent PCI prior to discharge. Unadjusted in-hospital mortality was higher in patients requiring early PCI following AVR (11.2 vs. 3.1%), MVR (24.1 vs. 5.5%), and MVr (22.4 vs. 2.5%) (P < 0.001) compared with patients not requiring PCI. Postoperative PCI remained independently associated with higher mortality after adjusting for demographics, comorbidities and hospital characteristics (adjusted OR [aOR] = 3.74, 95%CI 2.70-5.17 for AVR, aOR = 6.10, 95%CI 4.53-8.23 for MVR, and aOR = 9.90, 95%CI 7.22-13.58 for MVr). Patients undergoing PCI had higher incidences of stroke, acute kidney injury, infectious complications, higher hospital charges, and longer hospitalizations. Age, robotic-assisted surgery, and chronic renal failure were independent predictors of needing early postoperative PCI. CONCLUSIONS Early PCI after isolated aortic or mitral valve surgery is rare but is associated with substantial in-hospital morbidity, mortality, and cost. Further studies are needed to identify preventable causes, and optimal management strategies of this serious complication.
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Affiliation(s)
- Fahad Alqahtani
- Department of Medicine, Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Khaled Ziada
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Alkhouli
- Department of Medicine, Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
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3
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Sanghvi K, Walsh C, Varghese V. Ostial left main occlusion following surgical aortic valve replacement (SAVR). J Card Surg 2018; 33:139-141. [PMID: 29495122 DOI: 10.1111/jocs.13551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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4
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Todaro MC, Ielasi A, Silvestro A, Personeni D, Grigis G, Saino A, Tespili M. An unusual case of cardiogenic shock late following surgical aortic valve replacement. J Cardiol Cases 2016; 13:162-164. [PMID: 30546635 DOI: 10.1016/j.jccase.2016.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/30/2015] [Accepted: 01/26/2016] [Indexed: 11/30/2022] Open
Abstract
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.>.
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Affiliation(s)
| | - Alfonso Ielasi
- Cardiology Department, Bolognini Hospital, Seriate, Italy
| | | | | | | | - Antonio Saino
- Cardiology Department, Bolognini Hospital, Seriate, Italy
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Acute coronary syndrome as a result of left main coronary artery stenosis after aortic valve replacement. A report of three cases. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 9:150-4. [PMID: 24570708 PMCID: PMC3915960 DOI: 10.5114/pwki.2013.35450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 03/25/2013] [Accepted: 04/22/2013] [Indexed: 11/17/2022] Open
Abstract
Acute coronary syndrome (ACS) as a result of iatrogenic coronary ostial stenosis (ICOS) is a rare but potentially life-threatening complication of aortic valve replacement (AVR). We present three cases of patients with ACS shortly after AVR, in whom ICOS were revealed. They refused an operation and thus they were treated with percutaneous coronary intervention. The potential pathomechanisms of ICOS and treatment options are discussed.
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6
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Peruga JZ, Bielecka-Dabrowa A, Kasprzak JD. Is percutaneous transluminal coronary angioplasty the treatment of choice for iatrogenic stenosis of the left main coronary artery following aortic valve replacement? Heart Surg Forum 2013; 16:E190-2. [PMID: 23958529 DOI: 10.1532/hsf98.20111169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Iatrogenic coronary ostial stenosis after aortic valve replacement (AVR) is a rare but life-threatening complication. This condition has been treated with urgent coronary bypass surgery, but such surgery is associated with high morbidity and mortality. The clinical symptoms are usually severe and may appear from 1 to 6 months postoperatively. Pains in the chest that are typical for coronary artery disease but occur in patients after the AVR operation suggest a significant threat. We report a case of left main coronary artery ostial stenosis in a patient who had normal preoperative coronary angiography results. The patient was successfully treated with implantation of a drug-eluting stent.
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Affiliation(s)
- Jan Z Peruga
- Department of Cardiology, Medical University of Lodz, Poland.
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Kondo N, Yamamoto M, Kihara K, Wariishi S, Fukutomi T, Nishimori H, Orihashi K, Takeshima T, Imakubo K, Aki K. Development of a new selective coronary perfusion cannula. J Artif Organs 2013; 16:411-6. [PMID: 23903584 DOI: 10.1007/s10047-013-0721-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
Abstract
The two most common types of coronary perfusion cannulae currently being used are the "balloon type", with a balloon at the tip, and the "fenestrated type", which has holes along the side near the tip. However, on occasion an unusually high perfusion pressure or a considerable amount of leakage is encountered during infusion of the cardioplegic solution. We have examined the properties of a newly developed Kochi Medical School (KMS)-type cannula and compared these to the properties of the balloon-type and fenestrated-type cannulae in an ex vivo experimental model that contains ostia of 4, 3, or 2 mm in diameter. Ejected flow velocity, circuit pressure, and the amount of leakage were measured at an infusion rate of 100 and 200 mL/min, with the latter two parameters measured under the counterpressure of 0 and 50 cmH2O to examine the influence of coronary vascular resistance. Without counterpressure, the balloon type presented with the highest flow velocity (263 cm/s at 200 mL/min) and perfusion pressure (64 mmHg at 200 mL/min) but without leakage. The fenestrated type yielded a considerable amount of leakage (40 % at an ostium size of 2 mm). The KMS type showed a lower flow velocity and circuit pressure with less leakage. Under 50 cmH2O counterpressure, however, only the KMS-type cannula could inject the water to any ostium size at both flow rates. These results suggest that the concept of the KMS-type cannula may be advantageous to achieving a secure infusion to a diseased coronary ostium.
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Affiliation(s)
- Nobuo Kondo
- Department of Surgery II, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan,
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Progression of left main coronary artery disease 3 years after Bentall operation in a young female with Marfan syndrome. Cardiovasc Interv Ther 2012. [PMID: 23180109 DOI: 10.1007/s12928-012-0148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 39-year-old woman with Marfan syndrome presented to our hospital with chest oppression on effort. She underwent aortic root remodeling combined with aortic valve replacement 14 years ago and Bentall operation for enlargement of remaining native Valsalva sinus 3 years ago. A coronary computed tomography and a coronary angiography showed left main coronary artery stenosis, which was subsequently treated with percutaneous coronary intervention using a bare-metal stent. Follow-up coronary angiography performed 1 year after stenting revealed no restenosis.
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In-stent restenosis complicating stenting for iatrogenic stenosis of the left main, post aortic valve replacement: successful treatment with restenting. Int J Cardiol 2011; 148:361-3. [PMID: 20933290 DOI: 10.1016/j.ijcard.2010.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 09/17/2010] [Indexed: 11/20/2022]
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Gavrielatos G, Buttner HJ, Lehane C, Neumann FJ. Complex interventional procedures for the management of early postoperative left main coronary artery embolism after bioprosthetic aortic valve insertion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 12:68.e1-4. [PMID: 21241978 DOI: 10.1016/j.carrev.2010.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 05/06/2010] [Accepted: 05/20/2010] [Indexed: 11/28/2022]
Abstract
The incidence of calcified debris coronary embolism after aortic valve replacement (AVR) with a bioprosthesis is a rare but potentially life-threatening condition. We sought to describe a case of immediate postoperative left main coronary artery embolism, resulting to severe acute coronary syndrome and cardiogenic shock, after aortic valve surgery due to severe aortic valve stenosis, with the use of bioprosthesis. Complex interventional procedures and possible diagnostic challenges are being described.
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MIRKOVIC TOMISLAV, KNEZEVIC IVAN, BRECELJ ALEÅ, KRANJEC IGOR, NOC MARKO. Extrinsic Left Main Compression: Review of the Literature. J Interv Cardiol 2009; 22:550-5. [DOI: 10.1111/j.1540-8183.2009.00506.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Successful catheter-based management of iatrogenic left main coronary artery stenosis following aortic valve replacement. COR ET VASA 2008. [DOI: 10.33678/cor.2008.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Maltais S, El-Hamamsy I, Ducharme A, Carrier M, Pellerin M, Perrault LP. Late iatrogenic coronary stenosis after selective intraoperative antegrade myocardial protection for stentless aortic valve replacement. J Thorac Cardiovasc Surg 2006; 132:420-1. [PMID: 16872972 DOI: 10.1016/j.jtcvs.2006.03.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 03/23/2006] [Accepted: 03/28/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Simon Maltais
- Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
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Funada A, Mizuno S, Ohsato K, Murakami T, Moriuchi I, Misawa K, Kokado H, Shimada Y, Ishida K, Ohashi H. Three Cases of Iatrogenic Coronary Ostial Stenosis After Aortic Valve Replacement. Circ J 2006; 70:1312-7. [PMID: 16998265 DOI: 10.1253/circj.70.1312] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Iatrogenic coronary ostial stenosis (ICOS) is a rare but potentially life-threatening complication of aortic valve replacement (AVR). This complication is usually diagnosed by angiography and treated with aortocoronary bypass surgery. CASE REPORTS In the present 3 cases pre-operative coronary angiography confirmed normal coronary arteries and they underwent uncomplicated AVR. Coronary lesions were clinically manifest within 4 months after surgery, and repeat coronary angiography demonstrated bilateral ostial stenosis in 1 patient and left main trunk stenosis in the other 2. Two cases were detected by multidetector computed tomography (MDCT) before angiography. MDCT and Virtual Histology suggested fibrous tissue formation in the lesions. All 3 patients were successfully underwent percutaneous coronary intervention (PCI) and stenting. The post-procedure clinical course has been uneventful, except for elective stenting of a recurrent lesion in 1 asymptomatic patient. CONCLUSIONS The incidence of ICOS after AVR is low. Noninvasive MDCT is useful for early diagnosis and PCI is a possible alternative treatment. ICOS may be caused by fibrous tissue formation, and therefore be distinct from conventional atherosclerosis.
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Affiliation(s)
- Akira Funada
- Fukui Cardiovascular Center, Shinbo, Fukui, Japan.
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15
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Anthonio RL, Jessurun GAJ, Erasmus ME, Zijlstra F. Managing low profile - left main transmural laceration. ACTA ACUST UNITED AC 2005; 7:59-60. [PMID: 16019616 DOI: 10.1080/14628840510011144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Perforation of the left main stem is a rare complication associated with combined aortic valve replacement and by-pass surgery. One-year following aortic valve replacement a 70-year-old male presented with chest pain. This was related to a slowly expanding haematoma caused by a low profile chronic perforation of the left main. Subsequently, a tailored percutaneous modification of the main stem was performed. At three months follow-up, he had no complaints and selective coronary angiography confirmed the successful sealing of the perforation with a concomitant regression of the prior haematoma.
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Affiliation(s)
- Rutger L Anthonio
- Department of Cardiology, University Medical Centre Groningen Thorax Centre, The Netherlands.
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Abstract
Direct cannulation of the coronary ostia is a technique used by many surgeons in aortic valve surgery, especially when the valve is incompetent. It is safe and feasible, but the small risk of it causing a potentially devastating ostial stenosis must be kept in mind.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiovascular Surgery, Albert-Ludwigs-University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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