Percutaneous Management of Coronary Button Kinking After Emergency Aortic Root Replacement

Intimal windsock following type A aortic dissection: An intussusception of severe implications

BACKGROUND

A patient has presented with type A aortic dissection and computed tomography aortogram revealed proximal and distal aorta intimointimal intussusception.

MATERIAL & METHODS

The patient has undergone successful aortic root replacement surgery and on the way to his recovery, he developed inferolateral myocardial infarction with the troponin I leak.

RESULTS

The coronary angiogram showed a small contrast leak around the left button with no luminal compromise.

CONCLUSION

An intravascular ultrasound played a major part in the diagnosis of left main coronary artery compression due to the intramural hematoma. A drug-eluting stent was deployed to relieve the compression and to support the dissected layers of the coronary artery.

Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience

OBJECTIVES

Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports 'real-world' early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre.

METHODS

All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n = 47) in conjunction with PAR (ascending +/- root +/- arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement.

RESULTS

The median age was 58 years [interquartile range (IQR) 46-70]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day/in-hospital mortality. Preoperative AI was 3-4+ in 37 (79%) patients. Forty-one (87%) patients had zero-trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13 mmHg (IQR 5-20). Follow-up imaging was available in 32 (68%) patients at a median of 11 months (IQR 10-13) postsurgery. AI was ≤1+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up.

CONCLUSIONS

Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.

Extracorporeal membrane oxygenation-supported percutaneous angioplasty of coronary button stenosis after aortic root replacement

BACKGROUND AND AIM

A 73-year-old female patient had right coronary button stenosis following aortic root replacement.

METHODS

Myocardial ischemia led to hemodynamic instability followed by cardiogenic shock, which was successfully managed using venoarterial extracorporeal membrane oxygenation-supported right coronary button angioplasty.

RESULTS AND CONCLUSION

Although the incidence of such complications is low, it is a life-threatening event that requires prompt diagnosis and it may pose a challenging clinical scenario for the treating team.