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Two cases of iatrogenic left main coronary artery stenosis (ICOS) following aortic valve replacement (AVR) are documented. The first patient began to have chest pain due to myocardial ischemia 7 months after AVR. Angiographically, the ostium of her left coronary artery was severely stenotic. She refused coronary bypass grafting. She died of myocardial infarction due to ICOS, 23 months after AVR. Histologically, a loose cellular connective tissue was found around the stenotic coronary arterial lumen. The other patient had chest pain 4 months after aortic and mitral valve replacement. The ICOS was diagnosed angiographically. After she had coronary bypass grafting, she was free from myocardial ischemic symptoms. The onset of myocardial ischemic symptoms in the first six months after AVR is highly suggestive of ICOS, and urgent coronary angiography is recommended and, if proximal stenosis of the coronary arteries is diagnosed, coronary bypass grafting should be performed.
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