Iatrogenic left anterior descending artery stenosis early after aortic valve replacement presenting with T-wave-pseudonormalization - a case report

BACKGROUND Both iatrogenic coronary artery stenosis early after aortic valve replacement and pseudonormalization of inverted T-waves in acute ischemia are rare but well-recognized findings which coincide in this case. CASE PRESENTATION 10 weeks after aortic valve replacement, a 58-year-old male patient was readmitted with recent onset of unstable angina pectoris. Electrocardiography showed inverted T-waves in leads V2-4 with pseudonormalization during episodes of typical chest pain. Coronary angiography revealed subtotal ostial occlusion of the left anterior descending artery which was successfully treated by percutaneous coronary intervention. CONCLUSION Iatrogenic coronary artery stenosis is a potentially life-threatening complication that can occur early after aortic valve replacement in patients with normal preoperative coronary angiography. T-wave-pseudonormalization during episodes of angina pectoris may lead to misinterpretation in patients at high risk.