JACC. Case reports · 2025
Atypical Mechanism of Coronary Stenosis Due to TAVR in a Patient With Anomalous Coronary Anatomy.
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Nishimura Yuki, Sugane Hiroki, Fujita Takako, Okamoto Nao, Hosoda Hayato, Nishida Koji, Nakaoka Yoko, Kawai Kazuya, Tai Ryuta, Irie Hiroyuki
Аннотация
BACKGROUND: Transcatheter aortic valve replacement (TAVR) in patients with abnormal coronary anatomy remains challenging.
CASE SUMMARY: An 80-year-old man was referred to our hospital for TAVR. Computed tomography revealed an anomalous left coronary artery (LCA) originating from the right sinus of Valsalva. After TAVR, new coronary stenosis due to the compression by calcification at the sinus of Valsalva was confirmed by multimodality imaging.
DISCUSSION: In patients with this anomaly, coronary stenosis could occur in places other than the coronary ostium after TAVR. Calcification at the Valsalva sinus could directly compress the LCA after TAVR in patients with this anomaly. TAVR using a balloon-expandable valve under coronary protection would be a secure strategy for patients with this anomaly.
TAKE-HOME MESSAGE: Adequate valve choice with a prudent coronary protection strategy is important for TAVR in patients with the LCA originating from the right sinus of Valsalva.
CASE SUMMARY: An 80-year-old man was referred to our hospital for TAVR. Computed tomography revealed an anomalous left coronary artery (LCA) originating from the right sinus of Valsalva. After TAVR, new coronary stenosis due to the compression by calcification at the sinus of Valsalva was confirmed by multimodality imaging.
DISCUSSION: In patients with this anomaly, coronary stenosis could occur in places other than the coronary ostium after TAVR. Calcification at the Valsalva sinus could directly compress the LCA after TAVR in patients with this anomaly. TAVR using a balloon-expandable valve under coronary protection would be a secure strategy for patients with this anomaly.
TAKE-HOME MESSAGE: Adequate valve choice with a prudent coronary protection strategy is important for TAVR in patients with the LCA originating from the right sinus of Valsalva.