Remedy Publications LLC., | http://clinicsinsurgery.com/ Clinics in Surgery 2018 | Volume 3 | Article 2136 1 Acute Myocardial Infarction Ten Days after Bentall Procedure due to Coronary Embolism: Etiology Discussion and Rare Case Presentation OPEN ACCESS *Correspondence: Paolo Nardi, Department of Cardiac Surgery, Tor Vergata University Policlinic, Viale Oxford 81, 00133 Rome, Italy, Tel: +390620903536; Fax: +390620903538; E-mail: pa.nardi4@libero.it Received Date: 29 Aug 2018 Accepted Date: 01 Oct 2018 Published Date: 04 Oct 2018 Citation: Nardi P, Russo M, Greci M, Pisano C, Saitto G, Pellegrini G, , et al. Acute Myocardial Infarction Ten Days after Bentall Procedure due to Coronary Embolism: Etiology Discussion and Rare Case Presentation. Clin Surg. 2018; 3: 2136. Copyright © 2018 Paolo Nardi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Commentary Published: 04 Oct, 2018 Abs t ract Coronary thromboembolism is a rare cause of acute coronary syndromes (ACS, i.e. STEMI) and the data regarding ACS in patients with prosthetic heart valve are poor and based mainly on case report. Te likelihood of this focal coronary problem with normal coronary arteries is between 1% to 5% and several mechanisms have been proposed and reported. We here present the single case of a distal lef circumfex artery embolism afer Bentall procedure and hemiarch resectionin the setting of an acute type A aortic dissection successfully managed with conservative therapy and a brief comment on the actual literature. Paolo Nardi*, Marco Russo, Monica Greci, Calogera Pisano, Guglielmo Saitto, Giulio Pellegrini, Antonio Pellegrino,Carlo Bassano, Antonio Scafuri and Giovanni Ruvolo Department of Cardiac Surgery, Tor Vergata University Policlinic, Rome, Italy Commentary Coronary occlusion is a rare complication afer aortic and mitral valve surgery [1]. In literature some cases of prosthetic heart valve thrombosis-derived coronary embolism have been reported and several pathophysiologic mechanisms for this kind of event have been proposed. Tis event represents a rare cause of acute coronary syndromes (ACS, i.e. STEMI) and the data regarding ACS in patients with prosthetic heart valve are poor and based mainly on case report [1-2]. Te likelihood of this focal coronary problem with normal coronary arteries is between 1% to 5% [3]. Karakoyun and co-authors described three cases of prosthetic valve thrombosis causing non-ST elevation ACS, who was successfully treated with thrombolytic therapy [4]. Leontyev and colleagues described also a case of embolic occlusion of the lef main coronary artery following an isolated aortic valve replacement treated with emergent coronary artery bypass grafing [5]. Iatrogenic Coronary Ostial Stenosis (ICOS) could be associate with several mechanisms that have been previously described. Tukiji et al. reported that immunological reaction to the heterograf was a potential mechanism causing ostial coronary artery stenosis [6-7]. More, the direct coronary perfusion for myocardial protection during aortic valve surgery may produce immediate traumatic lesions and latest stenosis of the coronary arteries. Micro-injuries and local pressure necrosis might be related to the infusion pressure of the cardioplegic solution and over-dilatation of the vessel by the selective cannulation to delivery cardioplegia. In addition, intimal thickening and fbrous proliferation in proximity to the aortic root as a reaction to the turbulent fow around the prosthetic valves, as well as particulate embolism into the coronary arteries potentially related with a sub- therapeutic oral anticoagulation in patients with mechanical prostheses (Figure 1). Symptoms of ICOS, which usually develop within 6 months of surgery, can be rapidly progressive and may include angina pectoris, lef ventricle failure or acute pulmonary oedema. Tese complications require prompt clinical recognition and early treatment because of the possibility of sudden death. In other cases reasons of myocardial ischemia can be acute coronary occlusion by ostial obstruction by the valve prosthesis or arterial dissection due to cardioplegia’s cannula trauma. A sub-therapeutic oral anticoagulation could represent although rarely the main aetiology of an acute coronary events. Management of those complications are based on interventional or surgical procedures, or on medical therapy with thrombolytic therapy. Here we present the case of a 53 years-old man afected by acute Type A aortic dissection underwent Bentall procedure and hemiarch resection with mechanical composite graf CarboMedics 25/28 mm,(CarboMedics, Carboseal, Livanova, Saluggia, Vercelli, Italy) due to moderate hypothermia and bilateral anterograde cerebral perfusion. A complete dissection of Valsalva sinus and both coronary