Acute right coronary artery embolus after aortic valve surgery

Complex interventional procedures for the management of early postoperative left main coronary artery embolism after bioprosthetic aortic valve insertion

The incidence of calcified debris coronary embolism after aortic valve replacement (AVR) with a bioprosthesis is a rare but potentially life-threatening condition. We sought to describe a case of immediate postoperative left main coronary artery embolism, resulting to severe acute coronary syndrome and cardiogenic shock, after aortic valve surgery due to severe aortic valve stenosis, with the use of bioprosthesis. Complex interventional procedures and possible diagnostic challenges are being described.

Coronary embolism following valve surgery

A 55-year-old man experienced chest pain on the seventh day after valve surgery. Coronary angiography showed embolic occlusion of the left anterior descending coronary artery. The lesion was treated successfully with thrombectomy using the angiojet rheolytic thrombectomy system, resulting in rapid mechanical thrombolysis and removal via the effluent lumen of the catheter. Thrombolysis in Myocardial Infarction 3 flow was restored.

Huge thrombus growing on an aortic prosthetic valve detected in acute coronary syndrome

A 74-year-old woman with a history of aortic valve replacement (AVR) with a tilting prosthesis at the age of 59 was referred to our hospital with chest pain at rest. Following conservative treatment after admission, the laboratory findings demonstrated acute myocardial infarction. Although bilateral coronary arteries exhibited no significant stenosis and embolism on the emergency coronary angiogram, a huge mobile mass above the prosthetic valve was recognized on the aortography, computed tomography, and trans-esophageal echocardiography. Operative findings demonstrated that the huge mobile thrombus was growing from the sawing ring on the side of minor orifice and almost covered the ostium of the left coronary artery. Emergency re-AVR with 21 mm SJM HP valve was performed. This clinical course suggested that the acute coronary syndrome might be caused by the isolated thrombus on the aortic prosthetic valve without any insufficiency of prosthesis and embolic findings due to the thrombosed valve.

A case of vasospastic angina resulting from coronary emboli in a patient with prosthetic valves

In addition to coronary atherosclerotic disease, coronary thromboembolism can also lead to acute coronary syndromes. However, coronary thromboembolism due to prosthetic heart valves is very rare and not very well-known. It have been reported only a few cases. In this paper, we present a rare case with vasospastic angina pectoris secondary to coronary thromboembolism in a patient with prosthetic heart valves.