A case of right coronary artery obstruction and circulatory collapse in ICU after 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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Late onset of coronary ostial stenosis following surgical aortic valve replacement in a patient with anomalous origin of the right coronary artery

Journal of Cardiology Cases ◽

10.1016/j.jccase.2021.07.001 ◽

2021 ◽

Author(s):

Motoyoshi Takahara ◽

Yuta Imai ◽

Fumihiro Miyashita ◽

Yuki Uchio ◽

Masahiro Makino ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Right Coronary Artery ◽

Late Onset ◽

Anomalous Origin ◽

Surgical Aortic Valve Replacement ◽

Coronary Ostial Stenosis ◽

The Right

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Intraoperative right coronary artery obstruction due to aortic root prosthesis mismatch after aortic valve replacement—A case report

Journal of Cardiac Surgery ◽

10.1111/jocs.14227 ◽

2019 ◽

Vol 34 (11) ◽

pp. 1396-1398

Author(s):

Ashish M. Agrawal ◽

Divya Arora ◽

Aparesh Sanyal ◽

Shamsher Singh Lohchab

Keyword(s):

Case Report ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Right Coronary Artery ◽

Aortic Root ◽

Artery Obstruction

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Guide Extension-Assisted Stent Implantation at Ostial Right Coronary Artery Creating Stent Tunnel During Transcatheter Aortic Valve Replacement

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2020.04.022 ◽

2020 ◽

Vol 21 (11) ◽

pp. 50-53

Author(s):

Yumiko Kanei ◽

Waqas Qureshi ◽

Jennifer Walker ◽

Nikolaos Kakouros

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Right Coronary Artery ◽

Stent Implantation ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve

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Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivw049 ◽

2016 ◽

Vol 22 (6) ◽

pp. 806-812 ◽

Cited By ~ 15

Author(s):

Francesco Onorati ◽

Augusto D'Onofrio ◽

Fausto Biancari ◽

Stefano Salizzoni ◽

Marisa De Feo ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Artery Bypass ◽

Bypass Grafting ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve

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BASILICA Trial: One-Year Outcomes of Transcatheter Electrosurgical Leaflet Laceration to Prevent TAVR Coronary Obstruction

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.010238 ◽

2021 ◽

Vol 14 (5) ◽

Author(s):

Jaffar M. Khan ◽

Adam B. Greenbaum ◽

Vasilis C. Babaliaros ◽

Danny Dvir ◽

Mark Reisman ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

End Points ◽

Transcatheter Aortic Valve ◽

Artery Obstruction ◽

Coronary Obstruction

Background: Coronary artery obstruction is a rare, devastating complication of transcatheter aortic valve replacement. Transcatheter electrosurgical aortic leaflet laceration (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction [BASILICA]) is a novel technique to prevent coronary artery obstruction. We report the 1-year outcomes of the BASILICA trial. Primary end points of 30-day success and safety have been reported previously. Methods: The BASILICA trial was a prospective, multicenter, single-arm safety and feasibility study. Subjects with severe native or bioprosthetic aortic valve disease at high or extreme risk for surgery, and high risk of coronary artery obstruction, were included. End points at 1 year included death, stroke, and myocardial infarction. Source data was independently verified and end points independently adjudicated. Results: Thirty subjects were enrolled between February 2018 and July 2018. At 30 days, BASILICA was successful in 28 subjects (93.3%), there were 3 strokes (10%), including 1 disabling stroke (3.3%), 1 death (3.3%), and 1 periprocedural myocardial infarction (3.3%). Between 30 days and 1 year, there were no additional strokes, no myocardial infarction, and 2 deaths (10% 1-year mortality). No subject needed repeat intervention for aortic valve or coronary disease. Two subjects had infective endocarditis (6.7%), but neither was isolated to the aortic valve. There were no hospital admissions for heart failure. Fourteen (46.7%) subjects required repeat hospital admission for other causes. Aortic valve gradients on echocardiography, New York Heart Association functional class, and Kansas City Cardiomyopathy Questionnaire scores improved from baseline to 30 days and were maintained at 1 year. Conclusions: In these subjects with multiple comorbidities and restrictive anatomy that underwent transcatheter aortic valve replacement, there was no late stroke, myocardial infarction, or death related to BASILICA. Mitigation of coronary obstruction remained intact at 1 year and was not related to recurrent readmission. These results are reassuring for patients and physicians who wish to avoid the long-term complications related to snorkel stenting. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03381989.

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