A 34-year-old woman was hospitalized with shortness of breath and chest
tightness and pain. She had undergone aortic valve replacement for
aortic stenosis at the age of 18 years. Transthoracic echocardiography
showed left ventricular asynergy and a high aortic valve pressure
gradient. Thus, structural valve deterioration was diagnosed. Coronary
computed tomography and coronary angiography revealed left main trunk
ostial stenosis that had caused acute anteroseptal myocardial
infarction. Urgent surgery revealed pannus formation around the
prosthetic valve and covering the ostium of the left main trunk. A
Bentall procedure and coronary artery bypass grafting were performed.
The postoperative course was uneventful.