Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement

Syed Shahabuddin; Osama Ahmed Sami; Jamal Kabeer Khanv; Shahid Ahmed Sami

doi:doi:10.11648/j.js.20180603.11

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Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement

Syed Shahabuddin, Osama Ahmed Sami, Jamal Kabeer Khanv, Shahid Ahmed Sami

Published in Journal of Surgery (Volume 6, Issue 3)

Received: 11 January 2018 Accepted: 7 February 2018 Published: 7 May 2018

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Abstract

During aortic valve replacement, coronary artery obstruction is a rare but fatal complication. It may require revision of the surgical procedure including re-implantation of the valve or additional coronary revascularization. It is more common in the presence of abnormality of coronary artery like malposition or abnormal course. We report a case of 32 years old gentleman undergoing aortic valve replacement for severe aortic stenosis, having an abnormally placed left main coronary artery ostium. The risk of coronary ostial compression on seating the prosthetic valve was evident. A left main coronary artery unroofing was performed to translocate the ostium to avoid the obstruction. The patient recovered well intra and postoperatively and is doing well at nine months follow up.

Published in	Journal of Surgery (Volume 6, Issue 3)
DOI	10.11648/j.js.20180603.11
Page(s)	58-60
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Aortic Valve, Coronary Unroofing, Cardiac Surgery

References

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[2]	Santini F, Pentiricci S, Messina A, Mazzucco A. Coronary Ostial Enlargement to Prevent Stenosis After Prosthetic Aortic Valve Replacement. Ann Thorac Surg 2004; 77: 1854–6
[3]	Ziakas AG, Economou FI, Charokopos NA, Pitsis AA, Parharidou DG, Papadopoulos TI, Parharidis GE. Coronary ostial stenosis after aortic valve replacement: successful treatment of 2 patients with drug-eluting stents. Tex Heart Inst J. 2010; 37(4): 465-8.
[4]	Funada A, Mizuno S, Ohsato K, Murakami T, Moriuchi I, Misawa K, Kokado H, Shimada Y, Ishida K, Ohashi H. Three cases of iatrogenic coronary ostial stenosis after aortic valve replacement. Circ J. 2006 Oct; 70(10): 1312-7.
[5]	Sharma V, Burkhart HM, Dearani JA, Suri RM, Daly RC, Park SJ, Horner JM, Phillips SD, Scaff HV. Surgical unroofing of anomalous aortic origin of a coronary artery: a single-center experience. Ann Thorac Surg 2014; 98: 941–6.
[6]	Jang MS Choi JH, Han JH, Choi YI, Kim JM, Youn CY. Acute coronary obstruction after aortic valve replacement and role of transesophageal echocardiography. Anesth Pain Med 2017; 12:348–351.
[7]	Yamamoto M, Shimura T, Kano S, Kagase A, Kodama A, Koyama Y, Watanabe Y, Tada N, Takagi K, Araki M, Shirai S, Hayashida K. Impact of preparatory coronary protection in patients at high anatomical risk of acute coronary obstruction during transcatheter aortic valve implantation. Int J Cardiol. 2016 Aug 15; 217: 58-63.
[8]	Benedetti M, Pratali S, Scioti G, Petronio AS and Balbarini A. Solitary coronary ostium and aberrant coursing left coronary arteries: unfavorable anatomic anomaly in a case of aortic valve replacement [Letter]. J Thorac Cardiovasc Surg 1995; 109: 1259–1262.
[9]	Gulati R, Reddy VM, Culbertson C, Helton G, Suleman S, Reinhartz O, et al. Surgical management of coronary artery arising from the wrong coronary sinus, using standard and novel approaches. J Thorac Cardiovasc Surg 2007; 134: 1171–1178.
[10]	Nader J, Labont BA, Houpe D, Caus T. “ Killer coronary artery” and aortic valve stenosis: A tricky case. Asian Cardiovasc Thorac Ann. 2015 Nov; 23(9):1 079–82.
[11]	Farid S, Page A, Howell N, Goddard M, Abu-Omar Y, Jenkins DP, Nashef SA. Coronary ostial compromise in aortic valve replacement: an avoidable complication. Asian Cardiovasc Thorac Ann. 2015 Jun; 23(5): 535–42.

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APA Style

Syed Shahabuddin, Osama Ahmed Sami, Jamal Kabeer Khanv, Shahid Ahmed Sami. (2018). Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement. Journal of Surgery, 6(3), 58-60. https://doi.org/10.11648/j.js.20180603.11

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ACS Style

Syed Shahabuddin; Osama Ahmed Sami; Jamal Kabeer Khanv; Shahid Ahmed Sami. Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement. J. Surg. 2018, 6(3), 58-60. doi: 10.11648/j.js.20180603.11

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AMA Style

Syed Shahabuddin, Osama Ahmed Sami, Jamal Kabeer Khanv, Shahid Ahmed Sami. Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement. J Surg. 2018;6(3):58-60. doi: 10.11648/j.js.20180603.11

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@article{10.11648/j.js.20180603.11,
  author = {Syed Shahabuddin and Osama Ahmed Sami and Jamal Kabeer Khanv and Shahid Ahmed Sami},
  title = {Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement},
  journal = {Journal of Surgery},
  volume = {6},
  number = {3},
  pages = {58-60},
  doi = {10.11648/j.js.20180603.11},
  url = {https://doi.org/10.11648/j.js.20180603.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20180603.11},
  abstract = {During aortic valve replacement, coronary artery obstruction is a rare but fatal complication. It may require revision of the surgical procedure including re-implantation of the valve or additional coronary revascularization. It is more common in the presence of abnormality of coronary artery like malposition or abnormal course. We report a case of 32 years old gentleman undergoing aortic valve replacement for severe aortic stenosis, having an abnormally placed left main coronary artery ostium. The risk of coronary ostial compression on seating the prosthetic valve was evident. A left main coronary artery unroofing was performed to translocate the ostium to avoid the obstruction. The patient recovered well intra and postoperatively and is doing well at nine months follow up.},
 year = {2018}
}

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TY  - JOUR
T1  - Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement
AU  - Syed Shahabuddin
AU  - Osama Ahmed Sami
AU  - Jamal Kabeer Khanv
AU  - Shahid Ahmed Sami
Y1  - 2018/05/07
PY  - 2018
N1  - https://doi.org/10.11648/j.js.20180603.11
DO  - 10.11648/j.js.20180603.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 58
EP  - 60
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20180603.11
AB  - During aortic valve replacement, coronary artery obstruction is a rare but fatal complication. It may require revision of the surgical procedure including re-implantation of the valve or additional coronary revascularization. It is more common in the presence of abnormality of coronary artery like malposition or abnormal course. We report a case of 32 years old gentleman undergoing aortic valve replacement for severe aortic stenosis, having an abnormally placed left main coronary artery ostium. The risk of coronary ostial compression on seating the prosthetic valve was evident. A left main coronary artery unroofing was performed to translocate the ostium to avoid the obstruction. The patient recovered well intra and postoperatively and is doing well at nine months follow up.
VL  - 6
IS  - 3
ER  -

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Author Information

Syed Shahabuddin

Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
Osama Ahmed Sami

Dow International Medical College, Karachi, Pakistan
Jamal Kabeer Khanv

South City Hospital, Karachi, Pakistan
Shahid Ahmed Sami

Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

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Plain Text BibTeX RIS

APA Style

Syed Shahabuddin, Osama Ahmed Sami, Jamal Kabeer Khanv, Shahid Ahmed Sami. (2018). Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement. Journal of Surgery, 6(3), 58-60. https://doi.org/10.11648/j.js.20180603.11

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ACS Style

Syed Shahabuddin; Osama Ahmed Sami; Jamal Kabeer Khanv; Shahid Ahmed Sami. Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement. J. Surg. 2018, 6(3), 58-60. doi: 10.11648/j.js.20180603.11

Copy | Download

AMA Style

Syed Shahabuddin, Osama Ahmed Sami, Jamal Kabeer Khanv, Shahid Ahmed Sami. Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement. J Surg. 2018;6(3):58-60. doi: 10.11648/j.js.20180603.11

Copy | Download

@article{10.11648/j.js.20180603.11,
  author = {Syed Shahabuddin and Osama Ahmed Sami and Jamal Kabeer Khanv and Shahid Ahmed Sami},
  title = {Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement},
  journal = {Journal of Surgery},
  volume = {6},
  number = {3},
  pages = {58-60},
  doi = {10.11648/j.js.20180603.11},
  url = {https://doi.org/10.11648/j.js.20180603.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20180603.11},
  abstract = {During aortic valve replacement, coronary artery obstruction is a rare but fatal complication. It may require revision of the surgical procedure including re-implantation of the valve or additional coronary revascularization. It is more common in the presence of abnormality of coronary artery like malposition or abnormal course. We report a case of 32 years old gentleman undergoing aortic valve replacement for severe aortic stenosis, having an abnormally placed left main coronary artery ostium. The risk of coronary ostial compression on seating the prosthetic valve was evident. A left main coronary artery unroofing was performed to translocate the ostium to avoid the obstruction. The patient recovered well intra and postoperatively and is doing well at nine months follow up.},
 year = {2018}
}

Copy | Download

TY  - JOUR
T1  - Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement
AU  - Syed Shahabuddin
AU  - Osama Ahmed Sami
AU  - Jamal Kabeer Khanv
AU  - Shahid Ahmed Sami
Y1  - 2018/05/07
PY  - 2018
N1  - https://doi.org/10.11648/j.js.20180603.11
DO  - 10.11648/j.js.20180603.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 58
EP  - 60
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20180603.11
AB  - During aortic valve replacement, coronary artery obstruction is a rare but fatal complication. It may require revision of the surgical procedure including re-implantation of the valve or additional coronary revascularization. It is more common in the presence of abnormality of coronary artery like malposition or abnormal course. We report a case of 32 years old gentleman undergoing aortic valve replacement for severe aortic stenosis, having an abnormally placed left main coronary artery ostium. The risk of coronary ostial compression on seating the prosthetic valve was evident. A left main coronary artery unroofing was performed to translocate the ostium to avoid the obstruction. The patient recovered well intra and postoperatively and is doing well at nine months follow up.
VL  - 6
IS  - 3
ER  -

Copy | Download