# A Case of Acute Right Coronary Artery Ostial Obstruction Six Days After Surgical Aortic Valve Replacement Requiring Emergent Coronary Artery Bypass Grafting

## TL;DR

An elderly woman developed a life-threatening heart attack six days after heart valve surgery due to a blocked artery, requiring emergency treatment.

## Contribution

This case highlights the rare but critical risk of coronary artery obstruction after aortic valve replacement, even when initial blood flow appears normal.

## Key findings

- A patient developed ST-elevation myocardial infarction due to right coronary artery ostial obstruction six days after SAVR.
- Emergency CABG was required to save the patient after cardiogenic shock developed.
- The case emphasizes the need for vigilance regarding coronary artery occlusion risks beyond the immediate postoperative period.

## Abstract

Acute coronary artery obstruction after surgical aortic valve replacement (SAVR) is a rare but potentially life-threatening event that must be prevented. Here, we report a rare case of an 84-year-old woman who underwent SAVR with a 19-mm aortic bioprosthetic valve for severe aortic stenosis and who suddenly developed ST-elevation myocardial infarction six days after surgery as a result of right coronary artery (RCA) ostial obstruction. She experienced cardiogenic shock, and mechanical support devices were introduced; however, she underwent emergency coronary artery bypass grafting (CABG) to the RCA (#3) and survived. We were aware of the risk of RCA ostial obstruction intraoperatively but were unable to prevent it because blood flow was preserved in the early postoperative period. The present case is worth reporting because the patient developed fatal STEMI at a time when she would normally be considered for discharge. A major learning point from this case is that a coronary artery ostium that is patent immediately after SAVR may not be sufficient for patients considered at high risk of coronary artery occlusion.