Abstract
We present the case of a 61-year-old woman with a critical ostial stenosis of the left main coronary artery that most likely developed as a late complication following aortic valve replacement. She was treated by immediate successful percutaneous coronary intervention with stent implantation for cardiac arrest, most likely due to transient occlusion of the left main coronary artery during diagnostic catheterization.
The mechanism of stenosis development could be either injury to the left main coronary artery during selective cannulation for antegrade cardioplegia with late development of ostial stenosis, or injury to the aortic root during prosthesis implantation. The latter was the probable cause of the left main coronary ostial stenosis in our patient.
Development of iatrogenic coronary ostial stenosis after aortic valve replacement is very rare, but it is a potentially life-threatening situation that should be considered in the differential diagnosis of myocardial ischemia in patients after aortic valve replacement.