title: Left coronary ostial obstruction after aortic valve replacement with a supra-annular aortic valve.
abstract: We report a rare case of left coronary ostial obstruction after aortic valve replacement with a Top Hat supra-annular aortic valve, which was diagnosed with intraoperative transesophageal echocardiography and successfully treated with an unplanned coronary bypass. The patient was a 76-year-old woman (height 143 cm, weight 44 kg) with aortic stenosis and regurgitation. A 19-mm Top Hat valve was implanted in the supra-annular position because of a small aortic annulus. There was a possibility that the high profile of this prosthesis might block the left coronary ostium. There may be a problem with the use of this prosthesis in patients with small and rigid aortic roots with little compliance. Although the Top Hat valve has a great advantage for small aortic annuli, care in its use should be taken due to possible interference with the coronary ostia.
authors.affiliation: Department of Cardiovascular Surgery, Ibaraki Seinan Medical Center Hospital, Japan.
authors.forename: Kanji
authors.initials: K
authors.lastname: Matsuzaki
authors.forename: Hideya
authors.initials: H
authors.lastname: Unno
authors.forename: Taisuke
authors.initials: T
authors.lastname: Konishi
authors.forename: Osamu
authors.initials: O
authors.lastname: Shigeta
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D003327:Coronary Disease / Q000209:etiology*; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D011183:Postoperative Complications