Left coronary ostial embolization by a migrated pledget after redo mitral valve replacement: a case report
Year: 2026
Type: article
Study design: Case Report
Abstract: Redo mitral valve replacement is associated with increased surgical complexity and perioperative risk. Acute coronary obstruction caused by retained surgical materials is extremely rare but can lead to fatal myocardial ischemia. A 64-year-old woman with prior bioprosthetic mitral valve replacement underwent redo surgery for severe intraprosthetic regurgitation. Shortly after separation from cardiopulmonary bypass, she developed ventricular fibrillation and severe myocardial dysfunction, requiring reinstitution of bypass and subsequent extracorporeal membrane oxygenation (ECMO). Coronary angiography revealed a thrombus-like lesion at the left coronary ostium with preserved TIMI grade 3 flow; however, repeated aspiration failed to retrieve thrombotic material. Intravascular ultrasound demonstrated a solid non-thrombotic intraluminal obstruction. Surgical exploration confirmed complete occlusion of the left coronary ostium by a retained pledget from the previous operation. Removal of the pledget resulted in rapid improvement of myocardial contractility, and ECMO was successfully discontinued the following day. Coronary ostial embolization by retained pledget is a rare but life-threatening complication after redo mitral valve surgery. Early recognition, intravascular imaging, and timely surgical intervention with mechanical circulatory support are crucial for favorable outcomes.
Authors: Tongkai Ge, Dandong Luo, Jimei Chen, Xiaofeng Li
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,890
OpenAlex ID: W7225409313