Coronary ostial stenosis after aortic valve replacement: successful treatment of 2 patients with drug-eluting stents

• Published in: Texas Heart Institute journal Vol. 37; no. 4; pp. 465 - 468
• Main Authors: Ziakas, Antonios G, Economou, Fotios I, Charokopos, Nicholas A, Pitsis, Antonios A, Parharidou, Despina G, Papadopoulos, Thomas I, Parharidis, Georgios E
• Format: Journal Article
• Language: English
• Published: United States Texas Heart Institute 2010
• Subjects: Aged; Angina, Unstable - etiology; Angina, Unstable - therapy; Angioplasty, Balloon, Coronary - instrumentation; Aortic Valve - surgery; Case Reports; Coronary Angiography; Coronary Artery Bypass; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - etiology; Coronary Stenosis - therapy; Drug-Eluting Stents; Female; Heart Arrest, Induced - adverse effects; Heart Arrest, Induced - methods; Heart Valve Prosthesis Implantation - adverse effects; Humans; Male; Treatment Outcome; aortic valve/surgery; coronary artery disease/etiology/prevention & control; postoperative complications/therapy; iatrogenic disease/prevention & control; heart valve prosthesis implantation/adverse effects; coronary stenosis/diagnosis/etiology/therapy; cardiac surgical procedures/adverse effects; Angioplasty, transluminal, percutaneous coronary; treatment outcome; perfusion/adverse effects/instrumentation
• ISSN: 0730-2347; 1526-6702

Coronary ostial stenosis is a rare but potentially serious sequela after aortic valve replacement. It occurs in the left main or right coronary artery after 1% to 5% of aortic valve replacement procedures. The clinical symptoms are usually severe and may appear from 1 to 6 months postoperatively. Although the typical treatment is coronary artery bypass grafting, patients have been successfully treated by means of percutaneous coronary intervention.Herein, we present the cases of 2 patients in whom coronary ostial stenosis developed after aortic valve replacement. In the 1st case, a 72-year-old man underwent aortic valve replacement and bypass grafting of the saphenous vein to the left anterior descending coronary artery. Six months later, he experienced a non-ST-segment-elevation myocardial infarction. Coronary angiography revealed a critical stenosis of the right coronary artery ostium. In the 2nd case, a 78-year-old woman underwent aortic valve replacement and grafting of the saphenous vein to an occluded right coronary artery. Four months later, she experienced unstable angina. Coronary angiography showed a critical left main coronary artery ostial stenosis and occlusion of the right coronary artery venous graft. In each patient, we performed percutaneous coronary intervention and deployed a drug-eluting stent. Both patients were asymptomatic on 6-to 12-month follow-up. We attribute the coronary ostial stenosis to the selective ostial administration of cardioplegic solution during surgery. We conclude that retrograde administration of cardioplegic solution through the coronary sinus may reduce the incidence of postoperative coronary ostial stenosis, and that stenting may be an efficient treatment option.