Author(s): Joel T Levis, Geoffrey Schultz, Philip C Lee
Acute occlusive embolism to the coronary arteries resulting in acute myocardial infarction (AMI) is an uncommon occurrence. Although cases of patients with mechanical prosthetic heart valves resulting in this phenomenon have been reported in the setting of inadequate anticoagulation, reported cases resulting years after tissue aortic valve replacement (AVR) are rare. We report the case of a 50-year-old man who underwent a tissue AVR four years earlier and presented to the Emergency Department (ED) with an ST-segment elevation myocardial infarction. ED door-to-balloon time was delayed (at 115 minutes) because of pre-existing left bundle branch block on electrocardiogram. Emergent coronary angiography demonstrated complete occlusion of the left anterior descending coronary artery by a coronary embolus. The patient was successfully treated with percutaneous transluminal coronary angioplasty and aspiration thrombectomy, and subsequently underwent a transesophageal echocardiogram demonstrating thrombus on the tissue aortic valve prosthesis. This case demonstrates that coronary embolism resulting in AMI, while rare, can occur in patients years after tissue AVR surgery.