Abstract
BACKGROUND: A 63-year-old man underwent surgical aortic valve replacement with an On-X valve using COR-KNOT suturing to facilitate a mini-sternotomy approach. CASE SUMMARY: The patient presented with recurrent inferior ST-segment elevation myocardial infarctions over a few-year period, despite optimal anticoagulation therapy. Repeated coronary angiography showed no obstructive coronary artery disease or thromboembolic occlusion. Intravascular ultrasound showed a filling defect in the ostium of the right coronary artery (RCA). A cardiac computed tomography confirmed the interference between a COR-KNOT and the RCA. Percutaneous coronary intervention of the RCA ostium was performed with good outcomes. DISCUSSION: This is the first case to report a ST-segment elevation myocardial infarction caused by an automated suturing. The combination of mini-sternotomy with COR-KNOT may have contributed to this rare but serious complication. TAKE-HOME MESSAGES: Multimodality imaging is crucial in establishing unusual diagnoses. COR-KNOT may interfere with coronary flow resulting in transient coronary occlusion when used in surgical aortic valve replacement.