Three cases of iatrogenic coronary ostial stenosis after aortic valve replacement.
BACKGROUND
Iatrogenic coronary ostial stenosis (ICOS) is a rare but potentially life-threatening complication of aortic valve replacement (AVR). This complication is usually diagnosed by angiography and treated with aortocoronary bypass surgery.


METHODS
In the present 3 cases pre-operative coronary angiography confirmed normal coronary arteries and they underwent uncomplicated AVR. Coronary lesions were clinically manifest within 4 months after surgery, and repeat coronary angiography demonstrated bilateral ostial stenosis in 1 patient and left main trunk stenosis in the other 2. Two cases were detected by multidetector computed tomography (MDCT) before angiography. MDCT and Virtual Histology suggested fibrous tissue formation in the lesions. All 3 patients were successfully underwent percutaneous coronary intervention (PCI) and stenting. The post-procedure clinical course has been uneventful, except for elective stenting of a recurrent lesion in 1 asymptomatic patient.


CONCLUSIONS
The incidence of ICOS after AVR is low. Noninvasive MDCT is useful for early diagnosis and PCI is a possible alternative treatment. ICOS may be caused by fibrous tissue formation, and therefore be distinct from conventional atherosclerosis.
Funada
Akira
A
Fukui Cardiovascular Center, Shinbo, Fukui, Japan. a-funada@e-mail.jp
Mizuno
Sumio
S
Ohsato
Kazuo
K
Murakami
Tatsuaki
T
Moriuchi
Ikuo
I
Misawa
Katsushi
K
Kokado
Hiromasa
H
Shimada
Yoshifumi
Y
Ishida
Kentarou
K
Ohashi
Hirokazu
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001021:Aortic Valve / Q000601:surgery*; D023921:Coronary Stenosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D015607:Stents