Cardiovascular Disease: Student/Resident Case Report Poster - Cardiovascular Disease I |

Out of the OR but not Out of the Woods: A Case of Iatrogenic Coronary Ostial Stenosis Post Bentall Procedure FREE TO VIEW

Karan Wats, MBBS; Syeda Batul, MBBS; Sunil Abrol, MD; Micheal Friedman, MD
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Maimonides Medical Center, Brooklyn, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):87A. doi:10.1016/j.chest.2016.08.095
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SESSION TITLE: Student/Resident Case Report Poster - Cardiovascular Disease I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Iatrogenic coronary ostial stenosis is a rare but potentially fatal complication post aortic root surgery. We present a case of a middle aged male who came with the complaints of chest pain and found to have Left main coronary stenosis post Bentall procedure

CASE PRESENTATION: A 53 year old male smoker with a history of hypertension, diabetes mellitus, bicuspid aortic valve with aortopathy s/p bentall procedure 4 months prior, triple vessel disease s/p coronary artery bypass came to the hospital for sudden onset severe left side chest pain radiating to the arm associated with diaphoresis, shortness of breath. Initial electrocardiogram (EKG) was unremarkable but patient continued to have escalating pain when a repeat EKG later revealed ST elevations in aVR, V1-V3 with diffuse ST depression in lateral and inferior leads(Fig-1). Initial troponin on admission was noted to be 0.13. Intravenous heparin bolus was given, nitroglycerin infusion initiated and patient was taken for an urgent coronary angiogram which revealed 99% left main stenosis(Fig-2). . Patient also had brief episodes of non sustained ventricular tachycardia during the procedure.Angiography revealed TIMI I flow in left coronary system. Following pre-dilatation of left main coronary, flow improved. Drug eluting stent was deployed and post-dilatation inflations performed with good angiographic result and excellent flow. EKG normalized and no further arrhythmias were noted. Patient was discharged with aspirin and ticagrelor. He has been followed outpatient and remains asymptomatic.

DISCUSSION: Bentall procedure is a surgical procedure used commonly to treat aortopathies which involves composite graft replacement of the aortic valve, aortic root with reimplantation of the coronaries into the graft. Coronary artery stenosis is a rare but life threatening complication after Bentall procedure(1). It typically presents within the first 6 months after the procedure but has been reported up to 3 years. The mechanism involves a fibrous inflammatory reaction to the suture material or glue used during coronary re-implantation. Coronary artery bypass grafting is considered the treatment of choice for left main coronary artery disease but has been successfully treated with percutaneous intervention(PCI) and stent placement(2). Our patient presented unremitting chest pain, had brief episodes of non-sustained ventricular tachycardia so a decision was made to do immediate PCI with good outcomes

CONCLUSIONS: Iatrogenic coronary artery stenosis remains a rare but fatal sequelae after Bentall procedure and requires prompt intervention including PCI or CABG

Reference #1: Pande AK, Gosselin G. Iatrogenic left main coronary artery stenosis. J Invasive Cardiol 1995;7(6):183-7

Reference #2: Balbi M, Olivotti L, Scarano F, Bertero G, Passerone G, Brunelli C, Barsotti A. Percutaneous treatment of left main coronary stenosis as a late complication of Bentall operation for acute aortic dissection. Catheter Cardiovasc Interv 2004;62(3):343-5.

DISCLOSURE: The following authors have nothing to disclose: Karan Wats, Syeda Batul, Sunil Abrol, Micheal Friedman

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