Author + information
- Received August 11, 2011
- Accepted September 1, 2011
- Published online March 1, 2012.
- Frederic De Vroey, MD⁎ (, )
- Tim Glenie, MD,
- Alex Cicovic, MD,
- Peter Raudkivi, MD,
- Sally Greaves, MD and
- Mark Webster, MD
- ↵⁎Reprint requests and correspondence:
Dr. Frederic De Vroey, Cardiology Department, Green Lane, Cardiovascular Service, Auckland City Hospital, Park Road 1023 Grafton, Auckland, New Zealand
A 77-year-old man presented with an acute inferior ST-segment elevation myocardial elevation. One year earlier, he underwent aortic valve replacement for moderate aortic regurgitation and a dilated proximal ascending aorta. A 27-mm Freestyle stentless porcine bioprosthesis (Medtronic, Minneapolis, Minnesota) with a 28-mm Dacron cuff was used. The native coronary artery and aortic buttons were implanted into the porcine prosthesis using standard techniques.
Immediate coronary angiography revealed moderate left coronary disease. The right coronary artery (RCA) was engaged with the catheter toward the cranial edge of a funnel-shaped coronary ostium. An angiogram showed normal flow down the RCA without significant downstream disease. Soon after coronary injection, the patient had resolution of his chest pain and ST-segment elevation. An ascending aortogram confirmed a pedunculated mass that appeared attached to the caudal aspect of the RCA ostium (Fig. 1), oscillating with the cardiac cycle and intermittently obstructing the RCA (Online Videos 1 and 2). A transesophageal echocardiogram confirmed normal bioprosthetic function and a 2.2 × 1.0-cm mass, with the echo density of thrombus, in a dilated right coronary sinus.
Serial blood cultures were negative. The patient was treated conservatively with intravenous heparin and warfarin. A follow-up transesophageal echocardiogram 5 days later showed minimal residual thrombus in the RCA ostium. He remains well 3 months later.
A large pedunculated thrombus, presumably arising from the coronary anastomosis suture line, is a rare cause of ST-elevation myocardial infarction presenting late after aortic valve and root replacement.
For accompanying videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 11, 2011.
- Accepted September 1, 2011.
- American College of Cardiology Foundation