Severe chronic aortic regurgitation after percutaneous coronary intervention: a case report and literature review

Figures

• 

  Figure 1. The patient underwent her first coronary angiogram when she presented with central chest pain 28 months prior to admission to our institution. (A) The LAO 30° view showed an ostial total occlusion of the right coronary artery. (B) The culprit lesion was successfully treated with a drug-eluting stent (B).

• 

  Figure 2. Cardiac magnetic resonance imaging revealed a mild to moderate aortic regurgitation in a tricuspid aortic valve, and a mildly dilated left ventricle with a normal systolic function (left ventricular ejection fraction 66%). (A) The aortic regurgitant jet visualized in the five-chamber view. (B) Short-axis view showed a tricuspid aortic valve. (C) Region of interests for antegrade flow in the ascending aorta (red) and retrograde flow in the descending aorta (green). (D) Flow-vs.-time plot in the ascending aorta with a calculated antegrade flow of 113 mL/beat and a retrograde flow of 34 mL/beat, and aortic regurgitant fraction 30%.

• 

  Figure 3. Transthoracic echocardiography showed a severe aortic regurgitation in a severely dilated left ventricle (indexed left ventricular end-diastolic volume 94 mL/m2, normal value 29–61 mL/m2) and a mildly depressed systolic function (left ventricular ejection fraction 45%, normal value 54–74%). (A) Parasternal long-axis view showing the severely dilated left ventricle. (B) In the apical four-chamber view, the spherical form of the adversely remodelled left ventricle was appreciated. (C) The apical five-chamber colour-Doppler view displaying a severe aortic regurgitant jet. (D) Suprasternal view showing a holodiastolic backflow in the descending aorta with an end-diastolic velocity of 33 cm/s.

• 

  Figure 4. Perioperative transoesophageal echocardiography mid-oesophageal aortic valve long-axis view showing a stent protruding from the right coronary artery almost 1 cm into the Sinus of Valsalva (arrow).

• 

  Figure 5. Surgical aortic valve replacement to a mechanical aortic valve prosthesis was performed. (A) The aortotomy was performed and the protruding right coronary artery stent was visualized (arrow). (B) The protruding stent was grasped and gently pulled with forceps and the trimmed at the level of the right coronary artery ostium using a Mayo scissor (arrow).

•