Author/Authors :
Shin, Doosup Department of Internal Medicine - University of South Florida Morsani College of Medicine, Tampa, FL, USA , Huang, Kevin Department of Internal Medicine - University of South Florida Morsani College of Medicine, Tampa, FL, USA , Sunjic, Igor Department of Cardiovascular Sciences - University of South Florida Morsani College of Medicine, Tampa, FL, USA , Berlowitz, Michael Department of Cardiovascular Sciences - University of South Florida Morsani College of Medicine, Tampa, FL, USA , Prida, Xavier Department of Cardiovascular Sciences - University of South Florida Morsani College of Medicine, Tampa, FL, USA
Abstract :
Coronary ostial stenosis is a rare but potentially life-threatening complication that occurs in 1%–5% of patients who undergo
surgical aortic valve replacement (SAVR). Symptoms typically appear within the first 6 months and almost always within a year
after SAVR. We report an unusually delayed presentation of non-ST segment elevation myocardial infarction due to coronary
ostial stenosis 22 months after SAVR. A 71-year-old woman underwent uncomplicated SAVR with a bioprosthetic valve in August
2015 for severe aortic stenosis. A preoperative coronary angiogram demonstrated widely patent left and right coronary arteries. In
June 2017, the patient presented to the hospital with chest pain. An electrocardiogram demonstrated 1 mm ST segment depression
in the anterolateral leads, and serum troponin I level was elevated to 2.3 ng/ml. Diagnostic coronary angiography revealed severe
ostial stenosis (99%) of the right coronary artery. A bare-metal stent was successfully placed with an excellent angiographic result,
and the patient was asymptomatic at 4 months of follow-up after the procedure. As seen in our case, coronary ostial stenosis
should be considered in the differential diagnosis of chest pain or arrhythmia in patients presenting with a history of SAVR, even if
the procedure was performed more than 1 year prior to presentation.
