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Dynamic left main coronary artery stenosis caused by an aortic aneurysm after aortic valve replacement
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  1. G Hagenah,
  2. M Herzum,
  3. W Grimm
  1. grimmw{at}med.uni-marburg.de

https://doi.org/10.1136/bcr.2006.091025

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    A 69-year-old women with a history of aortic valve replacement two years previously had been admitted to our intensive care unit with a non-ST-segment elevation infarction. Coronary angiography showed a dynamic left main coronary artery stenosis (panels A and B). Aortic angiography revealed a proximal aortic aneurysm with a dimension of 2.0 × 4.6 cm (panel C). Transoesophageal echocardiography showed the neck of the aneurysm at the aortic prosthesis with pulse synchronous dynamic compression of the distal left main coronary artery and the proximal circumflex coronary artery (panel D). Subsequently, operative correction was performed without the need for coronary artery bypass grafting.

    Figure
    (A and B) Coronary angiography with pulse synchronous dynamic left main coronary artery stenosis. (C) Aortography in the right anterior oblique view denoting the aortic aneurysm (arrows) close to the aortic root. (D) Transoesophageal echocardiography (short axis) with colour Doppler showing the connection.

    Acknowledgments

    This article has been adapted from Hagenah G, Herzum M, Grimm W. Dynamic left main coronary artery stenosis caused by an aortic aneurysm after aortic valve replacement Heart 2007;93:518