Successful percutaneous coronary intervention of left main coronary artery dissection following mechanical aortic valve replacement surgery: a case report and literature review

TL;DR

A rare case of left main coronary artery dissection after heart surgery was successfully treated with a minimally invasive procedure.

Contribution

This case report provides a rare example of successful percutaneous coronary intervention for post-surgical LMCA dissection.

Findings

Percutaneous coronary intervention guided by intravascular ultrasound improved hemodynamic status in a patient with LMCA dissection.

Iatrogenic LMCA dissection is a rare but life-threatening complication of cardiac surgery.

Diagnostic coronary angiography and PCI may be effective postoperative management strategies for this condition.

Abstract

Iatrogenic left main coronary artery (LMCA) dissection resulting from cardiac surgery is a rare complication. Its early detection is challenging and often poses a significant threat to the patient's life. However, evidence regarding the most effective management strategy for this condition remains limited at present.

We present a case of 65-year-old female patient who developed cardiogenic shock after mechanical aortic valve replacement surgery associated acute myocardial infraction. Despite concurrent coronary artery bypass graft (CABG) surgery, the patient's condition remained unimproved. Subsequent coronary angiography revealed extensive LMCA dissection involving the left circumflex (LCx) artery. Percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) led to an immediate improvement in hemodynamic status. The patient was successfully discharged after 22 days of treatment.

Iatrogenic LMCA dissection is an uncommon complication following cardiac surgery. It can manifest in a variety of ways, including as incidental findings, cardiogenic shock or sudden cardiac arrest. The precise prevalence rates of causes linked to cardiac surgery remain largely unknown due to the scarcity of reported cases and the absence of research on this issue. Currently, a definitive management strategy for this condition has not been established. However, previous reported clinical cases provide insight that CABG could be considered if coronary artery dissection is detected during cardiac surgery. Upon postoperative identification, diagnostic coronary angiography and PCI may be feasible alternatives.

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