Ostial Left Main Obstruction From Pannus Formation in Severely Stenosed Bioprosthetic Aortic Valve.

BACKGROUND

Coronary obstruction from pannus after surgical aortic valve replacement (SAVR) is rare. We report a case of severe bioprosthetic aortic valve stenosis with concomitant ostial left main coronary artery (LMCA) obstruction, treated with SAVR alone.

CASE SUMMARY: A 73-year-old man with prior coronary artery bypass grafting and SAVR presented with acute heart failure. Multimodality imaging-echocardiography, angiography, and computed tomography-revealed severe bioprosthetic stenosis and critical LMCA obstruction from pannus. Redo SAVR included valve explantation, pannus excision at the LMCA ostium restoring coronary flow without bypass, and new bioprosthetic implantation.

DISCUSSION: Pannus can cause delayed LMCA obstruction after SAVR and should be suspected in symptomatic post-valve surgery patients. When percutaneous options are not feasible, redo SAVR with targeted pannus excision offers definitive treatment.

TAKE-HOME MESSAGES: Bioprosthetic pannus formation should be considered in the differential diagnosis of LMCA obstruction. Multimodality imaging and heart team collaboration are crucial for precise anatomical assessment and tailored intervention planning.