Delayed Development of Coronary Ostial Stenosis following Surgical Aortic Valve Replacement: A Case Report of Unusual Presentation

Abstract EN

Coronary ostial stenosis is a rare but potentially life-threatening complication that occurs in 1%–5% of patients who undergo surgical aortic valve replacement (SAVR).

Symptoms typically appear within the first 6 months and almost always within a year after SAVR.

We report an unusually delayed presentation of non-ST segment elevation myocardial infarction due to coronary ostial stenosis 22 months after SAVR.

A 71-year-old woman underwent uncomplicated SAVR with a bioprosthetic valve in August 2015 for severe aortic stenosis.

A preoperative coronary angiogram demonstrated widely patent left and right coronary arteries.

In June 2017, the patient presented to the hospital with chest pain.

An electrocardiogram demonstrated 1 mm ST segment depression in the anterolateral leads, and serum troponin I level was elevated to 2.3 ng/ml.

Diagnostic coronary angiography revealed severe ostial stenosis (99%) of the right coronary artery.

A bare-metal stent was successfully placed with an excellent angiographic result, and the patient was asymptomatic at 4 months of follow-up after the procedure.

As seen in our case, coronary ostial stenosis should be considered in the differential diagnosis of chest pain or arrhythmia in patients presenting with a history of SAVR, even if the procedure was performed more than 1 year prior to presentation.