Late onset of coronary ostial stenosis following surgical aortic valve replacement in a patient with anomalous origin of the right coronary artery

Background: A 47-year-old male presented with retrosternal chest pain, which had started 4 days previously and had become excruciating for the past 6 h. He had undergone mechanical aortic valve replacement surgery 4 months previously. Investigation: Electrocardiography, echocardiography, computed tomography-angiography of the aorta. Diagnosis: Rupture of the right sinus of Valsalva and right coronary artery dissection. Management: The defect in the right coronary sinus was closed, and the dissection at the root of the right coronary artery was resected and the right coronary artery bypassed to the root of the aorta.

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Low Origin of the Coronary Arteries and a Small Aortic Annulus Complicating Aortic Valve Replacement

Texas Heart Institute Journal ◽

10.14503/thij-18-6620 ◽

2019 ◽

Vol 46 (3) ◽

pp. 222-224 ◽

Cited By ~ 1

Author(s):

Milinda Withana ◽

Carlo Uribe ◽

Igor D. Gregoric ◽

Paolo Angelini

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Coronary Arteries ◽

Right Coronary Artery ◽

Perioperative Period ◽

Aortic Annulus ◽

Inferior Wall ◽

Surgical Aortic Valve Replacement

Low origin of the coronary arteries, defined as an origin less than 10 mm above the functional aortic annulus, is not usually considered to be a notable anomaly because functional impairment is not intrinsic. We describe a case of severe complications after surgical aortic valve replacement in a 59-year-old woman who had symptomatic aortic valve stenosis, low origin of both main coronary arteries, and a hypoplastic aortic annulus less than 19 mm in diameter. The aortic prosthesis had to be implanted above the hypoplastic anatomic annulus. An inferior-wall myocardial infarction, hypotension, right-sided heart failure, and atrial fibrillation developed during the early perioperative period. Coronary angiograms showed occlusion of the right coronary artery ostium and critical stenosis of the left coronary ostium. During reoperation, posterior aortic patch annuloplasty enabled lower reimplantation of the prosthetic aortic valve, jointly with right coronary artery–venous grafting. To prevent potentially severe complications, we recommend that low origin of the coronary arteries be reported before patients undergo surgical aortic valve replacement. If the ostia are not seen when routine coronary angiography is used, computed tomography should be prospectively performed to characterize this anomaly.

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Congenital Quadricuspid Aortic Valve Associated with Severe Regurgitation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230801600522 ◽

2008 ◽

Vol 16 (5) ◽

pp. e40-e41 ◽

Cited By ~ 6

Author(s):

Yujiro Kawanishi ◽

Hiroshi Tanaka ◽

Keitaro Nakagiri ◽

Teruo Yamashita ◽

Kenji Okada ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Right Coronary Artery ◽

Quadricuspid Aortic Valve ◽

Severe Aortic Regurgitation ◽

The Right

A 56-year-old man was referred because of severe aortic regurgitation. He had a quadricuspid aortic valve with a small accessory cusp between the right coronary and noncoronary cusps. The ostium of the right coronary artery was deviated toward the accessory cusp commissure. Aortic valve replacement was performed with a bioprosthesis. The resected cusps showed fibrotic thickening with calcification and fenestration.

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Aortic Valve Replacement and Concomitant Right Coronary Artery Bypass Grafting Performed via a Right Minithoracotomy Approach

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000081 ◽

2014 ◽

Vol 9 (4) ◽

pp. 302-305 ◽

Cited By ~ 2

Author(s):

Christos G. Mihos ◽

Orlando Santana ◽

Andres M. Pineda ◽

Angelo La Pietra ◽

Joseph Lamelas

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Right Coronary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

The Mean ◽

The Right

Objective We present our experience of concomitant right coronary artery bypass grafting (CABG) and aortic valve replacement performed via a right minithoracotomy in patients with coronary lesions not amenable to percutaneous intervention. Methods A total of 17 patients underwent concomitant aortic valve replacement and right CABG between April 2008 and July 2013.A5-to 6-cm minithoracotomy incision was made over the right second or third intercostal space, and the costochondral cartilage was transected. A saphenous vein bypass to the right coronary artery was then performed, initiating the anastomosis from the toe of the graft. Subsequently, the aortic valve was replaced using standard techniques. Results There were 6 men and 11 women. The median European System for Cardiac Operative Risk Evaluation II score mortality risk was 5% [interquartile range (IQR), 2%-8%]. The mean (SD) age was 77 (10) years, the left ventricular ejection fraction was 59% (8%), and the New York Heart Association functional class was 2.4 (0.8). One patient had a history of CABG. The mean (SD) cardiopulmonary bypass time was 168 (57) minutes, and the aortic cross-clamp time was 133 (36) minutes. Three patients underwent concomitant mitral valve surgery (replacement, 2; repair, 1). The median intensive care unit and hospital lengths of stay were 47 hours (IQR, 24–90) and 9 days (IQR, 5–13), respectively. There was one reoperation for bleeding, and there was one postoperative stroke. All patients were alive at a mean (SD) follow-up of 2 (1.1) years. Conclusions Aortic valve replacement with concomitant CABG performed via a right minithoracotomy approach is feasible.

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