Highlights that coronary ostial stenosis post-aortic valve replacement can be caused by prosthesis over-sizing and orientation, which can be successfully treated with prosthesis replacement and patch angioplasty.
Successful reoperation for prosthesis-related ostial stenosis yields durable result; hypothesis-generating and should not yet change practice.
Severe ostial stenosis of the coronary arteries following aortic valve replacement is a potentially lethal complication. The usual presentations are recent onset of severe angina, ventricular arrhythmias, congestive heart failure, and sudden death. It is generally accepted to arise from injury to the coronary arteries during direct cannulation and continuous perfusion of cardioplegia under high pressure during operation. We report on a patient who developed critical left coronary ostial stenosis after aortic valve replacement. The cause for the stenosis was probably related to the over-sizing and orientation of the prosthesis. The prosthesis was replaced and patch angioplasty of the left coronary ostia performed. The patient was well with normal coronary anatomy three years after surgery.
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Cheung et al. (1990) studied this question.
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