This aortic valve replacement (AVR) remains the gold standard for symptomatic aortic stenosis. Peri-operative complications like dissection, stenosis involving coronary artery are well described in many series. We pre...This aortic valve replacement (AVR) remains the gold standard for symptomatic aortic stenosis. Peri-operative complications like dissection, stenosis involving coronary artery are well described in many series. We present a rare iatrogenic complication of disrupted left main coronary artery during the delivery of cardioplegia while performing AVR in a 54 year male patient for severe calcific aortic stenosis. The inadvertent injury to the artery was timely noticed and managed successfully with long saphenous vein graft.展开更多
Left main coronary compression syndrome(LMCS)may complicate pulmonary artery aneurysms(PAA),usually developed in the context of pulmonary arterial hypertension(PAH).We report the case of a 51-year-old female patient w...Left main coronary compression syndrome(LMCS)may complicate pulmonary artery aneurysms(PAA),usually developed in the context of pulmonary arterial hypertension(PAH).We report the case of a 51-year-old female patient with an atrial septal defect(unsuitable for device closure)complicated by a PAA generating a 90%left main stenosis.The significant PAH held us back from immediate surgery.After specific dual PAH-targeted therapy(sildenafil and bosentan),the atrial septal defect could be closed with a unidirectional valved patch;the PAAinduced LMCS was treated by reductive arterioplasty.The postoperative course was uneventful.Follow-up showed clinical improvement,but PAH treatment was still needed.After three months,coronary angiography showed only an insignificant residual left main stenosis,proving that reductive pulmonary arterioplasty was effective in treating LMCS.Any PAA requires further evaluation for LMCS,a dangerous but treatable complication.The“treat-repair-treat”strategy and shunt-closure with a unidirectional valved patch can both improve surgical prospects of LMCS with shunt-related PAH.展开更多
Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current ...Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current world. The three cardinal signs of severe AS are dyspnea, syncope, and angina. Transcatheter aortic valve implantation is one of the safe and effective methods for treating severe aortic valve stenosis, and an alternative to surgery in high-risk patients. Aortic valve calcification and changes after TAVI were specifically assessed by computed tomography. Excessive aortic valve calcification is related to procedural complications. A possible consequence is obstruction of coronary ostia. Heavy calcification of the aortic valve and surrounding structure is an important risk factor for coronary obstruction, heart block, and embolization during aortic valve implantation (TAVI). Here we present a case of an elderly old man, where critical ostial left main coronary artery (LMCA) disease was caused by shifting of a calcium speck rather than obstruction with native leaflet. He was successfully rescued by an emergent CABG. Methods and Results: This is a case of a 69-year-old man with severe calcific aortic stenosis and single-vessel CAD who underwent TAVI with a relatively unremarkable course. Notably, his pre-operative TAVI angiography showed no LMCA stenosis. But 10 days later he presented to the ER with acute myocardial infarction with peak high-intensity troponins, diffuse ST changes, and cardiogenic shock. Urgent coronary angiography and intravascular ultrasound showed critical LMCA stenosis caused by a speck of calcium externally abating the vessel. He underwent emergency coronary artery bypass grafting;intraoperative TEE confirmed the etiology. He had an uneventful postoperative course and was successfully weaned off vasoactive medications. Conclusion: This case illustrates that obstruction of coronary ostia could be a possible complication of TAVI. Calcium distribution should factor in TAVI versus surgical candidacy. Calcium shifting should be watched closely during valve deployment, post-TAVI coronary angiogram should be considered if shifting was significant or suspected to compromise coronary arteries.展开更多
文摘This aortic valve replacement (AVR) remains the gold standard for symptomatic aortic stenosis. Peri-operative complications like dissection, stenosis involving coronary artery are well described in many series. We present a rare iatrogenic complication of disrupted left main coronary artery during the delivery of cardioplegia while performing AVR in a 54 year male patient for severe calcific aortic stenosis. The inadvertent injury to the artery was timely noticed and managed successfully with long saphenous vein graft.
文摘Left main coronary compression syndrome(LMCS)may complicate pulmonary artery aneurysms(PAA),usually developed in the context of pulmonary arterial hypertension(PAH).We report the case of a 51-year-old female patient with an atrial septal defect(unsuitable for device closure)complicated by a PAA generating a 90%left main stenosis.The significant PAH held us back from immediate surgery.After specific dual PAH-targeted therapy(sildenafil and bosentan),the atrial septal defect could be closed with a unidirectional valved patch;the PAAinduced LMCS was treated by reductive arterioplasty.The postoperative course was uneventful.Follow-up showed clinical improvement,but PAH treatment was still needed.After three months,coronary angiography showed only an insignificant residual left main stenosis,proving that reductive pulmonary arterioplasty was effective in treating LMCS.Any PAA requires further evaluation for LMCS,a dangerous but treatable complication.The“treat-repair-treat”strategy and shunt-closure with a unidirectional valved patch can both improve surgical prospects of LMCS with shunt-related PAH.
文摘Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current world. The three cardinal signs of severe AS are dyspnea, syncope, and angina. Transcatheter aortic valve implantation is one of the safe and effective methods for treating severe aortic valve stenosis, and an alternative to surgery in high-risk patients. Aortic valve calcification and changes after TAVI were specifically assessed by computed tomography. Excessive aortic valve calcification is related to procedural complications. A possible consequence is obstruction of coronary ostia. Heavy calcification of the aortic valve and surrounding structure is an important risk factor for coronary obstruction, heart block, and embolization during aortic valve implantation (TAVI). Here we present a case of an elderly old man, where critical ostial left main coronary artery (LMCA) disease was caused by shifting of a calcium speck rather than obstruction with native leaflet. He was successfully rescued by an emergent CABG. Methods and Results: This is a case of a 69-year-old man with severe calcific aortic stenosis and single-vessel CAD who underwent TAVI with a relatively unremarkable course. Notably, his pre-operative TAVI angiography showed no LMCA stenosis. But 10 days later he presented to the ER with acute myocardial infarction with peak high-intensity troponins, diffuse ST changes, and cardiogenic shock. Urgent coronary angiography and intravascular ultrasound showed critical LMCA stenosis caused by a speck of calcium externally abating the vessel. He underwent emergency coronary artery bypass grafting;intraoperative TEE confirmed the etiology. He had an uneventful postoperative course and was successfully weaned off vasoactive medications. Conclusion: This case illustrates that obstruction of coronary ostia could be a possible complication of TAVI. Calcium distribution should factor in TAVI versus surgical candidacy. Calcium shifting should be watched closely during valve deployment, post-TAVI coronary angiogram should be considered if shifting was significant or suspected to compromise coronary arteries.
