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Case reports

Coronary ostial stenosis after aortic valvuloplasty (comprehensive aortic root and valve repair)

Department of Cardiovascular Medicine, Konkuk University School of Medicine, 4-12 Hwayang-dong, Kwangjin-ku, Seoul, 143-729 South Korea

Received 10 September 2008; received in revised form 22 October 2008; accepted 22 October 2008.

^_* Corresponding author. Tel.: +82 2 2030 7512; fax: +82 2 2030 6069. (Email: khryu{at}kuh.ac.kr).

Comprehensive aortic root and valve repair (CARVAR) surgery using specially designed aortic rings was introduced as a new surgical technique for aortic valve disease. We present five consecutive cases of iatrogenic coronary ostial stenosis after CARVAR surgery in patients with aortic stenosis. The preoperative coronary angiography confirmed that all the patients had normal coronary arteries. They underwent aortic valvuloplasty by aortic leaflet extension and insertion of specially designed inner and outer rings at the level of the sinotubular junction. Within 6 months after surgery, all the patients complained of resting chest pain and dyspnea with changes of electrocardiography. Repeated coronary angiography demonstrated right coronary artery (RCA) ostial stenosis in one patient and left main (LM) ostial stenosis in the other four patients. Intravascular ultrasonography demonstrated severe ostial stenosis and extensive echogenic tissue in the extravascular area. Four patients with LM ostial disease successfully underwent coronary bypass graft surgery, and percutaneous coronary intervention with stenting was performed in one case of RCA ostial stenosis. Because the mechanism of this complication is not fully confirmed, more clinical study is required to confirm the safety issues of CARVAR surgery.

Key Words: Aortic valve repair • Coronary stenosis • Coronary artery bypass