Late acute coronary syndrome 9 months after uneventful transcatheter aortic valve replacement

Le résumé fourni par la source

An 84-year-old woman with symptomatic aortic stenosis underwent transfemoral aortic revalving (CoreValve 26 mm). Nine months later, after an uneventful period, she was admitted because of acute coronary syndrome and ECG signs of anterior wall ischaemia (Panel A, red box). Transthoracic echocardiography revealed a severe anterior hypokinesia and preserved prosthetic valve (PV) function. An attempt to perform a coronary angiography failed to show both coronary ostia. The dramatic clinical setting with the onset of cardiogenic shock led to emergent surgical revascularization by left internal thoracic artery (LITA) on the left anterior descending artery (LAD) and a venous graft (VG) on the right coronary artery (RCA). The postoperative 2D–3D CT reconstruction of the aortic native valve (NV) and aortic root showed incomplete subluxation of the valve prosthesis (Panels B and C, blue arrow) and a concomitant fibrotic/thrombotic thickening within the prosthetic valve struts (Panel D, yellow arrow), leading to subocclusion of the left coronary ostium (Panels B and C, full white arrow). To the best of our knowledge, this is the first case showing combination of aortic valve prosthesis subluxation and fibrotic/thrombotic thickening of the struts causing acute myocardial ischaemia.

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