Case 87
Stent in Aortic Root
Question
This patient was undergoing an angioplasty and stenting of an osteal RCA lesion and the stent was deployed as shown. Should you be doing anything?
A stent has been deployed that is obviously butting out into the aortic root. Surgical clips indicate previous surgery. The worry here is that the stent end will perforate the cup of the aortic valve causing torrential AR. The coronary stenosis seems to have been cured though, just diffuse disease left. If the patient is not fit then things are easy - no operation. If the patient is reasonably fit then the stent needs removing and the aortic valve needs inspecting. If the stent can be removed and the valve is normal just graft the RCA, however if the aortic valve leaflet has been damaged then an AVR and graft to the RCA is needed.
Note this lady has previous surgical clips. If she has had a previous sternotomy, she will face a high operative risk, and conservative management may be best.
Obviously we are assuming no other pathology exists.
