Iatrogenic left anterior descending artery stenosis early after aortic valve replacement presenting with T-wave-pseudono
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CASE REPORT
Open Access
Iatrogenic left anterior descending artery stenosis early after aortic valve replacement presenting with T-wave-pseudonormalization - a case report Stefan Schwarz1*, Hermann Blessberger1, Jürgen Kammler1, Christoph Gross2 and Clemens Steinwender1
Abstract Background: Both iatrogenic coronary artery stenosis early after aortic valve replacement and pseudonormalization of inverted T-waves in acute ischemia are rare but well-recognized findings which coincide in this case. Case presentation: 10 weeks after aortic valve replacement, a 58-year-old male patient was readmitted with recent onset of unstable angina pectoris. Electrocardiography showed inverted T-waves in leads V2-4 with pseudonormalization during episodes of typical chest pain. Coronary angiography revealed subtotal ostial occlusion of the left anterior descending artery which was successfully treated by percutaneous coronary intervention. Conclusion: Iatrogenic coronary artery stenosis is a potentially life-threatening complication that can occur early after aortic valve replacement in patients with normal preoperative coronary angiography. T-wave-pseudonormalization during episodes of angina pectoris may lead to misinterpretation in patients at high risk. Keywords: Iatrogenic coronary artery stenosis, Aortic valve replacement, Pseudonormalization, Percutaneous coronary intervention
Background Pseudonormalization of abnormal T-waves in spontaneous or provoked ischemia was first described by Noble et al. [1]. The underlying electrophysiological mechanism generally thought to apply is a superposition of acute ischaemic effects on the action potential of subepicardial cells on top of chronic ischaemic effects [2]. Among other probable causes, T-wave inversion in the anterior precordial leads usually reflects severe left anterior descending coronary artery stenosis [3]. Development of angina pectoris within a few months after aortic valve replacement is highly suspicious for iatrogenic proximal coronary artery stenosis [4]. These two rare findings of clinical cardiology coincide in this case. Case presentation We report the case of a 58-year-old male patient undergoing valve replacement surgery for symptomatic aortic valve stenosis. Coronary heart disease had been ruled * Correspondence: [email protected] 1 1st Medical Department - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Krankenhausstrasse 9, 4020 Linz, Austria Full list of author information is available at the end of the article
out preoperatively by coronary angiography. Valve replacement surgery was performed using a St. Jude 25 mm mechanical valve prosthesis (St. Jude Medical Inc., St. Paul, MN, USA). During surgery, cardioplegic solution was administered by selective antegrade ostial cannulation using a 3mm coronary artery perfusion cannula with a 6mm balloon tip (CalMed Laboratories, Costa Mesa, CA, USA). Postoperative recovery and rehabilitation were unremarkable without symptoms of angina pectoris. 10 weeks after surgery,
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