title: Left main coronary artery bifurcation angioplasty and stenting after aortic valve replacement: a case report.
abstract: A 43-year-old young lady had closed mitral valvotomy (CMV) in 1994 and aortic valve replacement (AVR) in June 2007. Shortly thereafter, she presented with unstable angina in October 2007 with on-going pain and haemodynamic instability. Coronary angiogram showed tight left main bifurcation stenosis in a left dominant system. Having had open heart surgery (AVR) recently, and being on oral anticoagulation, with on-going ischaemia and unstable haemodynamics, percutaneous coronary intervention (PCI) was considered the most suitable option. She underwent successful PCI with two drug-eluting stents (T-stenting) to left main bifurcation through transradial approach and intra-aortic balloon support. Clinically she remained symptom free and coronary angiogram after 5 months and 15 months of follow-up showed patent stents. This case demonstrates the acute effectiveness of PCI for the treatment of critical left main disease following open heart surgery in patients who are not appropriate surgical candidates.
authors.affiliation: Department of Cardiology, Fortis Escorts Hospital, Jaipur. sanjeeb.roy@fortishealthcare.com
authors.forename: Sanjeeb
authors.initials: S
authors.lastname: Roy
authors.forename: Ajeet
authors.initials: A
authors.lastname: Bana
authors.forename: Rajeev
authors.initials: R
authors.lastname: Gupta
authors.forename: Rakesh
authors.initials: R
authors.lastname: Chittora
authors.forename: Sameer
authors.initials: S
authors.lastname: Sharma
authors.forename: Navneet
authors.initials: N
authors.lastname: Mehta
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D001021:Aortic Valve / Q000601:surgery*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome