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Case Reports
. 2012;39(3):393-7.

Iatrogenic left main coronary ostial stenosis after a Bentall procedure in an asymptomatic young man

Chiara Bernelli  1 , Gian Paolo Bezante, Claudio Brunelli, Manrico Balbi
Affiliations
Case Reports

Iatrogenic left main coronary ostial stenosis after a Bentall procedure in an asymptomatic young man

Chiara Bernelli et al. Tex Heart Inst J. 2012.

Abstract

Coronary ostial stenosis is a rare but potentially fatal sequela of aortic surgery. The clinical presentation can include acute coronary syndromes, ventricular arrhythmias, congestive heart failure, or sudden death. Herein, we present what we believe is the first reported case of asymptomatic iatrogenic left main coronary ostial stenosis. The patient was an active 34-year-old man who had undergone a modified Bentall procedure and was asymptomatic thereafter. Seven months after that operation, exercise stress testing showed electrocardiographic signs of asymptomatic myocardial ischemia at high workload, and coronary angiography revealed severe nonatherosclerotic left main ostial stenosis. Percutaneous coronary intervention and stenting of the unprotected left main stenosis was successful, and patency at 8 months was apparent on coronary angiography.The conventional treatment for coronary ostial stenosis, coronary artery bypass grafting, carries a high risk of perioperative infarction, morbidity, and death. We found that percutaneous coronary intervention with stenting yielded positive short- and long-term results and may provide an alternative to cardiac surgery in these high-risk patients. We recommend that physicians evaluate even asymptomatic patients for left main coronary ostial stenosis after aortic surgery so that early diagnosis and treatment can avert severe clinical manifestations.

Keywords: Aortic diseases/surgery; awareness; coronary angiography/methods; coronary disease/radiography; coronary stenosis/diagnosis/etiology/therapy; exercise/physiology; iatrogenic disease; percutaneous coronary intervention; postoperative complications/therapy; treatment outcome.

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Figures

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Fig. 1 Electrocardiogram during stress testing shows diffuse ST-segment downsloping and T-wave inversion at high workload.
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Fig. 2 Coronary angiograms after a Bentall procedure show severe nonatherosclerotic left main stenosis in A) right and B) left anterior views.
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Fig. 3 Percutaneous coronary intervention in iatrogenic unprotected left main stenosis after 8 months. Coronary angiograms (right anterior view) show A) placement of a 4 × 13-mm bare-metal stent, and B) resultant Thrombolysis in Myocardial Infarction grade 3 flow.
See this image and copyright information in PMC

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