Right Coronary Ostium Occlusion Secondary to Aortic Valve Prosthesis Implantation in a Patient On ECMO. Image In Medicine

Abstract

Coronary artery obstruction as an acute presentation is a rare complication in the context of open surgical aortic valve replacement. We present a case of acute right ostial coronary occlusion immediately after aortic valve replacement. The patient was admitted to the intensive care unit where right-sided cardiogenic shock was documented, and he was placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO). He underwent urgent percutaneous revascularization, with placement of a venous blood conduit from the saphenous vein to the right coronary artery. Reported cases of coronary artery obstruction secondary to surgical aortic valve replacement with bioprostheses or mechanical prostheses are much less frequent than those reported after transcatheter aortic valve replacement. However, recognition of this complication confers timely intervention for the surgical emergency approach, together with adequate hemodynamic support, as fundamental pillars to restore ventricular function and stabilize the patient.