Acute Myocardial Infarction Due to Left Main Trunk Ostial Stenosis Occurring in the Acute Phase After Aortic Valve Replacement

Coronary ostial stenosis is a rare but critical complication after aortic valve replacement. We present a patient with acute myocardial infarction that occurred eight days after aortic valve replacement. The patient had favorable progress until eight days after the operation, but she suddenly developed ventricular fibrillation and then pulseless electrical activity; thus, she was placed on venoarterial extracorporeal membrane oxygenation. Emergent coronary angiography revealed severe stenosis without thrombus nor dissection in the left main trunk orifice, and we realized that the prosthetic valve stent was quite close to the left main trunk orifice. She underwent stent implantation, and TIMI III flow was achieved. She could be weaned from venoarterial extracorporeal membrane oxygenation in 12 days and was stabilized without inotropes. Unfortunately, she was complicated by fungal sepsis and died from multi-organ failure 37 days after index surgery. The majority of coronary ostial stenosis is reported to occur within a few months after surgery because of its pathophysiological mechanisms. The onset of coronary ostial stenosis in the acute phase after surgery like in our case is not common. The deformity of the aortic complex after aortic valve replacement may trigger a left main trunk ostial stenosis. The change of aortic complex geometry after aortic valve replacement should be noted, especially in small patients or narrow aortic annulus.