Iatrogenic left anterior descending artery stenosis early after aortic valve replacement presenting with T-wave-pseudonormalization - a case report

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.