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Case Reports
. 2024 Jan 19;16(1):e52560.
doi: 10.7759/cureus.52560. eCollection 2024 Jan.

Aortic Regurgitation After Right Coronary Cusp Injury During Percutaneous Coronary Intervention

Taylor Bowman  1 , Donal O'Donoghue  2 , Jose L Diz Ferre  3 , Leonardo A Marquez Roa  3 , Richard Hofstra  3 , Sabry Ayad  2   3
Affiliations
Case Reports

Aortic Regurgitation After Right Coronary Cusp Injury During Percutaneous Coronary Intervention

Taylor Bowman et al. Cureus. .

Abstract

Injury of a coronary cusp of the aortic valve is a rare complication that can occur during coronary angiography. It usually occurs from multiple attempts with different catheters to access the ostia of the right coronary artery, but it has also occurred accessing the ostia of the left coronary artery. We present the case of a patient who underwent coronary angiography with suspected coronary cusp injury that remained asymptomatic but was found to have severe aortic regurgitation during coronary artery bypass graft surgery (CABG) one week later, requiring an aortic valve replacement.

Keywords: iatrogenic aortic regurgitation; left heart catheterization; right coronary cusp injury; surgical aortic valve replacement (savr); transesophageal echocardiogram (tee).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PCI scan
Still image from TTE that occurred before PCI. Green arrow shows an intact aortic valve. PCI - percutaneous coronary intervention; TTE - transthoracic echocardiogram
Figure 2
Figure 2. PCI scan
Still image from PCI. Red arrow: catheter descending from the aorta with dye flowing through it. Green arrow: tip of the catheter near aortic valve location. Pink arrow: right coronary ostia. Blue arrows: right coronary artery with very faint amount of dye entering the artery. Yellow arrows: large amount of dye blowing back into the aorta. PCI - percutaneous coronary intervention
Figure 3
Figure 3. New aortic insufficiency
New aortic insufficiency was found on intraoperative TTE prior to CABG and aortic valve repair and replacement. TTE - transesophageal echocardiogram; CABG - coronary artery bypass graft surgery
Figure 4
Figure 4. Mobile mass
AV LAX view showing mobile mass attached to AV during systole (green arrow) AV - aortic valve; LAX - long axis
Figure 5
Figure 5. Mobile mass
AV LAX view showing mobile mass attached to AV Right coronary cusp prolapsing into LVOT (green arrow) AV - aortic valve; LAX - long axis; LVOT - left ventricular outflow tract
Figure 6
Figure 6. Mobile mass
3D view of mobile mass taken from LVOT (green arrow) LVOT - left ventricular outflow tract
See this image and copyright information in PMC

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