Iatrogenic coronary artery stenosis at the ostium of left anterior descending artery after aortic valve replacement: a case report with imaging and histological findings.

Iatrogenic coronary artery stenosis (ICAS) after aortic valve replacement (AVR) is a rare but potentially fatal complication. Immediate traumatic lesions or late stenoses caused by insertion of an antegrade cardioplegia catheter during AVR mostly occur at the site of the left main trunk or right coronary ostium. Here, we report a rare case of ICAS after AVR at the ostium of left anterior descending artery. Intravascular ultrasound provided helpful information to choose and perform directional coronary atherectomy (DCA) as the strategy of percutaneous coronary intervention. Histological examination of the specimen taken by DCA demonstrated intimal hyperplasia and no findings of atheromatous plaque with lipid core or thrombus. The patient has been asymptomatic after the procedure and the follow-up multidetector computed tomography at 1 year showed no restenosis.