Left coronary ostial stenosis developing 15 months after transcatheter aortic valve replacement with balloon-expandable valve

Naoto Kuyama, Kazuhiro Nakao, Hideaki Kanzaki, Yusuke Shimahara, Tatsuya Nishii, Yuki Irie, Shinya Ichihara, Yasuhide Asaumi, Chisato Izumi, Tomoyuki Fujita, Teruo Noguchi, Satoshi Yasuda

Research output: Contribution to journalArticlepeer-review

Abstract

We present the case of an 82-year-old man whose left coronary ostium became obstructed 15 months after transcatheter aortic valve replacement (TAVR) with a balloon-expandable valve. The patient underwent TAVR for symptomatic severe aortic stenosis with no complications. Fifteen months after the initial TAVR, the patient complained of chest pain while exercising, and the exercise stress myocardial perfusion scintigraphy demonstrated the development of regional myocardial ischemia in the region of the left coronary artery. Coronary angiography implied severe stenosis in the ostium of the left coronary artery. Computed tomography angiography and intravascular ultrasonography indicated a soft tissue component along with stent struts, which was considered to cause delayed coronary obstruction. Our report emphasizes the importance of having a low threshold for clinically suspecting delayed coronary obstruction in patients who have undergone TAVR, even after several years of the procedure. <Learning objective:Delayed coronary obstruction (DCO) should be suspected in patients presenting with new ischemic symptoms after transcatheter aortic valve replacement (TAVR). DCO may occur even in the case of TAVR with a balloon-expandable prosthetic valve, on antithrombotic regimens, and several years after the initial procedure.>

Original languageEnglish
Pages (from-to)115-118
Number of pages4
JournalJournal of Cardiology Cases
Volume25
Issue number2
DOIs
Publication statusPublished - 2022 Feb

Keywords

  • Coronary ostium stenosis
  • Delayed coronary obstruction
  • Transcatheter aortic valve replacement

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