Coronary Ostial Stenosis

Coronary ostial stenosis developing after aortic valve replacement is a clinically well-recognized entity. This non-atheromatous intimal proliferation may be limited to the proximal part of the coronary artery, probably as a complication of intra-operative coronary perfusion. It may also occur in association with widespread intimal thickening in the aortic root, presumedly as a reaction to turbulence around aortic ball valve prostheses. We have encountered this process in 2/508 patients (0.4%), who underwent aortic valve replacement with the Björk-Shiley tilting disc valve prosthesis. The coronary perfusion technique was identical in all the operations. Both the above-mentioned patients experienced disabling angina pectoris within 5 months of valve replacement and had developed a short stenosis proximally in the main left coronary artery. Both were relieved by coronary artery bypass grafting. Our first 160 consecutive aortic valve replacements with the Björk-Shiley prosthesis were analysed with reference to disabling angina and coronary ostial stenosis. There were 17 late deaths and 8 late re-operations, all demonstrating patency of the coronary orifices and absence of intimal thickening in the proximal aorta. One patient in this group (<1%) suffered from disabling angina due to ostial stenosis. Coronary ostial stenosis may develop as a complication of coronary artery perfusion or of aortic valve replacement with ball valve prostheses. The incidence of this complication can, however, be kept at low and acceptable levels by a gentle technique of coronary perfusion and by using a central flow tilting disc valve prosthesis for aortic valve replacement.