Structural Heart Disease > Cases

Left Main Ostial Stenosis after Aortic Valve Replacement, Treated by Stenting
- Operator : Yong Huo, MD
Case presentation
A 51-year-old man was referred to First Hospital Peking University, Beijing, China because of increasing exertional dyspnea for 6 months. Echocardiogram revealed severe aortic valve stenosis and preoperative coronary angiogram was normal. In September 2001, he underwent aortic valve replacement with tissue prostheses. She had undergone operation with antegrade delivery of cold blood cardioplegia and direct cannulation of both coronary ostia.
Six months later, he admitted to First Hospital Peking University, Beijing, China with a 1-month history of increasing chest pain on exertion. On admission, resting electrocardiogram showed ST depression of 0.5 mm in precordial leads. An echocardiographic study showed good function of the prosthetic valves and left ventricular ejection fraction was 66% without regional wall motion abnormality.
Coronary angiography after aortic valve replacement

1. Repeat coronary angiogram showed tight stenosis at LMCA ostium (Figure 1 and Figure 2). By QCA analysis, reference vessel diameter was measured 4.3 mm with a lesion MLD of 1.1 mm and a lesion length of 6.2 mm (% diameter stenosis= 74 %).

2. LCX and RCA were normal.

Procedure
A 7F sheath was inserted through right femoral artery and the left coronary was engaged with a 7F, 4 cm curve left Judkins catheter. Left main to LAD was wired with 0.014F BMW wire. After pre-dilation with a 2.5 mm x 16 mm Braun Larus balloon (Figure 3), the LMCA ostium was stented with a 4.0 mm x 8 mm Braun Coroflex stent to cover only the LMCA ostium (Figure 4). Then, post-dilation to achieve stent optimization was performed upto 16 atm with stent balloon (Figure 5). Final angiogram showed a good result with QCA measurement of LMCA MLD of 4.1 mm (Figure 6 and Figure 7).
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