Left Main Coronary Artery Occlusion After Percutaneous Aortic Valve Implantation Antonio L. Bartorelli, MD, Daniele Andreini, MD, Erminio Sisillo, MD,

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Left Main Coronary Artery Occlusion After Percutaneous Aortic Valve Implantation Antonio L. Bartorelli, MD, Daniele Andreini, MD, Erminio Sisillo, MD, Gloria Tamborini, MD, Melissa Fusari, MD, Paolo Biglioli, MD The Annals of Thoracic Surgery Volume 89, Issue 3, Pages 953-955 (March 2010) DOI: 10.1016/j.athoracsur.2009.08.024 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Aortic root angiogram before transcatheter heart valve deployment showing the low left main coronary artery take-off (arrow) (A), after transcatheter heart valve positioning (B), and deployment showing left main coronary artery occlusion (arrow) (C). (TEE = transesophageal echocardiography probe.) The Annals of Thoracic Surgery 2010 89, 953-955DOI: (10.1016/j.athoracsur.2009.08.024) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Transesophageal echocardiography evaluation of diastolic left main coronary artery jet flow (arrows) that is present before transcatheter heart valve implantation (A), disappears immediately after (B), and is restored after coronary stenting (C). The Annals of Thoracic Surgery 2010 89, 953-955DOI: (10.1016/j.athoracsur.2009.08.024) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Coronary angiogram after left main coronary artery recanalization (arrow) with balloon angioplasty (A). Final result after coronary stent implantation (B). (TEE = transesophageal echocardiography probe; IABP = intra-aortic balloon pump catheter.) The Annals of Thoracic Surgery 2010 89, 953-955DOI: (10.1016/j.athoracsur.2009.08.024) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) Intravascular ultrasound images of the left main coronary artery after balloon angioplasty (note the eccentric atherosclerotic plaque from 2 to 5) (A) and stent implantation (B). The Annals of Thoracic Surgery 2010 89, 953-955DOI: (10.1016/j.athoracsur.2009.08.024) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Multi-detector computed tomography scan. (A) Volume-rendering reconstruction showing the transcatheter heart valve (THV) and left main coronary artery stent (arrow). (B) Maximum intensity projection showing the spatial relationship between the THV and coronary stent (arrow). (C) Diastolic multi-planar reconstruction at the level of the THV leaflets and the stented left main coronary artery (arrow). (RCA = right coronary artery.) The Annals of Thoracic Surgery 2010 89, 953-955DOI: (10.1016/j.athoracsur.2009.08.024) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions