Dr. Osamu Matsuda, Dr. Hiroyuki Kimura
Hiroshima Heart Center
Male, 50s
Height: 155cm
Weight: 54kg
Current Medical History
He was referred to the hospital for a thorough examination of coronary artery calcification after a chest CT scan during a physical examination.
CTCA showed severe stenosis in the left anterior descending branch, and the patient was scheduled for CAG.
Medical History and Risk Factors
No special information.
Medication
Pregabalin 2C
Potentially diastolic murmur?
Summary
Aortic regurgitation occurred during PCI of a left main lesion.
The immediate post-PCI course was good, but after six months, the patient developed symptomatic heart failure.
Aortic valvuloplasty was performed 10 months after PCI.
Discussion
First of all, the left coronary artery was quite posterior and started from a slightly elevated position. An extra catheter was used, which was difficult to engage during the procedure causing the guiding catheter tip to push against the aorta which possibly resulted in damaging the valve. As the other possible cause of the valvular damage, the patient was thought to have some kind of congenital anomaly in his body due to his short stature and gait disorder. The surgeon in charge of the operation commented that the valve was much weaker than usual. This case reminded us of the importance of daily auscultation in the outpatient clinic, because guiding catheter operations may cause aortic injury or aortic valve injury.
Comment from Dr. Kimura
Because of the young age of the patient, we performed an autologous pericardial valve replacement (AVNeo) without anticoagulation. The patient is now doing well after the surgery.
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