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Nguyen KA, Keshavamurthy S, Yoon J, Kashem MA, Toyoda Y. Right Coronary Artery Button Pseudoaneurysm After the Modified Bentall Procedure. Cureus 2023; 15:e40144. [PMID: 37425512 PMCID: PMC10329497 DOI: 10.7759/cureus.40144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Anastomoses of the coronary buttons are the Achilles' heel of the modified Bentall procedure (MBP) for the repair of the aortic root and ascending aorta. We present a rare case of post-MBP right coronary artery button pseudoaneurysm in a 30-year-old man. The contained leak, attributed to a pseudoknot in the polypropylene suture, was visualized via computed tomography angiography and transesophageal echocardiogram and repaired under deep hypothermic circulatory arrest.
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Affiliation(s)
- Kaitlin A Nguyen
- Department of Surgery, Division of Cardiovascular Surgery, Temple University Hospital, Philadelphia, USA
| | | | - Jeongae Yoon
- Department of Anesthesiology, University of Maryland, Baltimore, USA
| | - Mohammed A Kashem
- Department of Surgery, Division of Cardiovascular Surgery, Temple University Hospital, Philadelphia, USA
| | - Yoshiya Toyoda
- Department of Surgery, Division of Cardiovascular Surgery, Temple University Hospital, Philadelphia, USA
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2
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Yang A, Jacob JC, DeMarco C, Marcadis P, Chung M, Jacobi A. Postoperative imaging of thoracic aortic repairs. Clin Imaging 2023; 101:8-21. [PMID: 37262963 DOI: 10.1016/j.clinimag.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/05/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
Imaging plays a crucial role in the postoperative monitoring of thoracic aortic repairs. With the development of multiple surgical techniques to repair the ascending aorta and aortic arch, it can be a daunting challenge for the radiologist to diagnose potential pathologies in this sea of various techniques, each with their own normal postoperative appearance and potential complications. In this paper, we will provide a comprehensive review of the postoperative imaging in the setting of thoracic aortic repairs, including the role of imaging, components of thoracic aortic repairs, the normal postoperative appearance, and potential complications.
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Affiliation(s)
- Anthony Yang
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America.
| | - Julia C Jacob
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
| | - Cody DeMarco
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
| | - Philip Marcadis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
| | - Michael Chung
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
| | - Adam Jacobi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
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3
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Structural abnormalities after aortic root replacement with stentless xenograft. J Thorac Cardiovasc Surg 2023; 165:1285-1297.e6. [PMID: 34116854 DOI: 10.1016/j.jtcvs.2021.04.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/11/2021] [Accepted: 04/24/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In complex and high-risk aortic root disease, the porcine Freestyle stentless bioprosthesis (Medtronic Inc, Minneapolis, Minn) is an important surgical treatment option. We aimed to determine prevalence and clinical effect of structural and functional abnormalities after full-root Freestyle implantation. METHODS Our cross-sectional 2-center study combined with clinical follow-up included 253 patients with full-root Freestyle bioprostheses implanted from 1999 to 2017. Patients underwent transthoracic echocardiography (TTE) and contrast-enhanced, electrocardiogram-gated 4-dimensional cardiac computed tomography (4DCT) at median age 70 (interquartile range, 62-75) years. After 4DCT, clinical follow-up continued throughout 2018. Median follow-up was 3.3 years before 4DCT and 1.4 years after. RESULTS We identified abnormalities in 46% of patients, including pseudoaneurysms (n = 32; 13%), moderate or severe coronary ostial stenosis (n = 54; 21%), and moderate-severe leaflet thickening or reduced leaflet motion (n = 51; 20%). TTE only identified 1 patient with pseudoaneurysm. After 4DCT, the unadjusted hazard ratio for surgical reintervention among patients with abnormal 4DCT was 4.2 (95% confidence interval, 1.2-15.3), in all, 10% required a reintervention. 4DCT abnormalities were associated with a statistically nonsignificant increased risk of death, stroke, or myocardial infarction (hazard ratio obtained using Cox proportional hazards regression analysis, 2.4; 95% confidence interval, 0.7-7.6). In all, 4.0% died, 3.6% had a myocardial infarction, and 2.0% had a stroke. CONCLUSIONS Structural and functional abnormalities of the aortic root are frequent after Freestyle implantation and TTE appears to be insufficient for follow-up. Abnormalities might be associated with increased risk of reintervention and potentially adverse clinical outcomes. Longer follow-up and larger study populations are needed to further clarify the clinical implications of abnormalities identified with 4DCT.
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4
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Sugimura K, Miyasaka M, Nakashima M, Tada N. Usefulness of 3-Dimensional Reconstruction Images of Coronary Computed Tomography Angiogram in Percutaneous Coronary Intervention After Bentall Operation. Tex Heart Inst J 2022; 49:487436. [DOI: 10.14503/thij-21-7601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Anastomotic complications of the coronary arteries were observed in approximately 5% of patients undergoing Bentall-type surgery. Given the high surgical risk of reoperation, percutaneous coronary intervention could be a treatment for anastomotic complications but is challenging because of the complicated anatomy after Bentall-type surgery. Here, a 70-year-old man underwent a Bentall operation during which the left main coronary artery was accidentally injured. Therefore, coronary artery bypass using a saphenous vein graft was performed. The saphenous vein graft was anastomosed from the right side of the aortic graft to the left main coronary artery. Three years later, the patient presented with an anterior non–ST-segment elevation myocardial infarction. Because his unusual anatomy, the saphenous vein graft could not be cannulated with diagnostic catheters, even after perusing the surgical record of the Bentall surgery. Subsequently, coronary computed tomography angiography was performed. Three-dimensional reconstructed images visualized the positional relationship between the saphenous vein graft and anatomical landmarks, such as the implanted surgical valve prosthesis. The angiogram angle was adjusted using these landmarks and projection angles estimated by the images. Then, the ASAHI Hyperion Judkins right 4 catheter could be easily inserted, and percutaneous coronary intervention was successfully performed. Three-dimensional reconstruction images were useful for performing percutaneous coronary intervention by aiding in the identification of the anatomic location of the saphenous vein graft and the positional relationship between the saphenous vein graft and anatomic landmarks. In patients with unusual anatomy, as in this case, coronary computed tomography angiography should be strongly considered.
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Affiliation(s)
- Kazunori Sugimura
- 1 Department of Cardiovascular Center, Sendai Kousei Hospital, Miyagi, Japan
| | - Masaki Miyasaka
- 1 Department of Cardiovascular Center, Sendai Kousei Hospital, Miyagi, Japan
| | - Masaki Nakashima
- 1 Department of Cardiovascular Center, Sendai Kousei Hospital, Miyagi, Japan
| | - Norio Tada
- 1 Department of Cardiovascular Center, Sendai Kousei Hospital, Miyagi, Japan
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5
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Milano AD, Bortolotti U. Coronary button dehiscence after the modified Bentall procedure. J Card Surg 2022; 37:2928. [PMID: 35612345 DOI: 10.1111/jocs.16641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Aldo D Milano
- Division of Cardiac Surgery, University Hospital of Bari, Bari, Italy
| | - Uberto Bortolotti
- Division of Cardiac Surgery, University Hospital of Bari, Pisa, Italy
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6
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Comentale G, Pinna GB, Parisi V, Manzo R, Pilato E. Incidental finding of rare and huge asymptomatic pseudoaneurysm after Bentall procedure: A challenging case report. J Card Surg 2022; 37:1773-1775. [PMID: 35286731 DOI: 10.1111/jocs.16415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
We report the case of a 62-year-old male who underwent urgent cardiac surgery due to the incidental finding of a huge and asymptomatic coronary button pseudoaneurysm at an 18-month outpatients clinic follow-up requiring a very complex preoperative planning.
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Affiliation(s)
- Giuseppe Comentale
- Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.,Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni B Pinna
- Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Rachele Manzo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Emanuele Pilato
- Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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7
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Kostopoulou A, Fountas E, Karapanagiotou O, Kyrzopoulos S. Inappropriate shocks from a transvenous implantable defibrillator caused by atrial fibrillation and a missed atrial septal defect in a patient with a modified Bentall procedure. Eur Heart J Case Rep 2021; 5:ytab412. [PMID: 34870086 PMCID: PMC8637801 DOI: 10.1093/ehjcr/ytab412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/19/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Inappropriate shocks have been reported in ∼1/3 of patients with implantable cardiac defibrillators (ICDs). We report an unusual case of inappropriate ICD shocks due to atrial fibrillation (AF) caused by a missed atrial septal defect (ASD) in a patient with a modified Bentall procedure.
Case summary
A 67-year-old Caucasian male, with an ICD and a history of a modified Bentall procedure 24 years ago, reported to our outpatient clinic with recurrent inappropriate ICD shocks due to episodes of fast AF. The transthoracic echocardiographic exam revealed two large aneurysms at the ostia of the coronary arteries. We performed further evaluation with transoesophageal echocardiogram and computed tomography (CT) angiography. The aneurysms measured on CT were 3.14 cm × 2.29 cm on the right ostium and 1.9 cm × 0.99 cm on the left. A large secundum type ASD of 1.5 cm, missed in all previous echocardiographic studies, was revealed. The therapeutic options of surgical closure of the ASD and repair of the aneurysms or a more conservative approach with percutaneous closure of the ASD and closer follow-up were discussed with the patient. The patient declined the surgical option due to high complication risk, and closure of the ASD with an Amplatzer device was performed 3 months later. A 3-year follow-up was uneventful.
Conclusion
It is of major importance to comprehensively and thoroughly assess patients before and after a surgical intervention to not miss other treatable conditions preoperatively and complications in the postoperative period.
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Affiliation(s)
- Anna Kostopoulou
- Department of Electrophysiology and Pacing, Onassis Cardiac Surgery Center, Syngrou 356, 17674 Kallithea, Greece
| | - Epameinontas Fountas
- Laboratory of Echocardiography, Onassis Cardiac Surgery Center, Syngrou 356, 17674 Kallithea, Greece
| | - Olga Karapanagiotou
- Laboratory of Imaging, Onassis Cardiac Surgery Center, Syngrou 356, 17674 Kallithea, Greece
| | - Stamatis Kyrzopoulos
- Laboratory of Echocardiography, Onassis Cardiac Surgery Center, Syngrou 356, 17674 Kallithea, Greece
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8
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Vendramin I, Bortolotti U, De Manna DN, Lechiancole A, Sponga S, Livi U. Combined Replacement of Aortic Valve and Ascending Aorta-A 70-Year Evolution of Surgical Techniques. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:118-123. [PMID: 34634836 PMCID: PMC8598315 DOI: 10.1055/s-0041-1729913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Simultaneous replacement of the ascending aorta and aortic valve has always been a challenging procedure. Introduction of composite conduits, through various ingenious procedures and their modifications, has changed the outlook of patients with aortic valve disease and ascending aorta pathology. In the past 70 years, progress of surgical techniques and prosthetic materials has allowed such patients to undergo radical procedures providing excellent early and long-term results in both young and elderly patients. This article aims to review the most important technical advances in the treatment of aortic valve disease and ascending aorta aneurysms recognizing the important contributions in this field.
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Affiliation(s)
- Igor Vendramin
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital, Udine, Italy
| | - Uberto Bortolotti
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital, Udine, Italy
| | - Davide Nunzio De Manna
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital, Udine, Italy
| | - Andrea Lechiancole
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital, Udine, Italy
| | - Sandro Sponga
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital, Udine, Italy
| | - Ugolino Livi
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital, Udine, Italy
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Scaffa R, Torre M, Longobardi A, Ferrara D, Vassallo MG, Itri F, Coscioni E. Giant Distal Anastomotic Pseudoaneurysm 35 Years after Bentall Operation Mimicking an “Elephant Trunk”. AORTA 2021; 9:193-195. [PMID: 34879402 PMCID: PMC8654511 DOI: 10.1055/s-0041-1732399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present the case of a giant distal aortic pseudoaneurysm 35 years after a classic mechanical Bentall operation. Computed tomography and coronary angiography showed that this originated from the distal suture line. The proximal suture and coronary ostia appeared to be intact. At reoperation, we found a complete dehiscence of distal suture line: the graft was floating in the pseudoaneurysm, mimicking an “elephant trunk” procedure. This complication suggested a systematic and accurate follow-up of patients who underwent an original Bentall procedure.
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Affiliation(s)
- Raffaele Scaffa
- Division of Cardiac Surgery, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Mario Torre
- Division of Cardiac Surgery, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Antonio Longobardi
- Division of Cardiac Surgery, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - David Ferrara
- Division of Cardiac Surgery, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Maria G. Vassallo
- Division of Cardiac Surgery, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Francesco Itri
- Division of Cardiac Surgery, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Enrico Coscioni
- Division of Cardiac Surgery, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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10
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Marquis KM, Naeem M, Rajput MZ, Raptis DA, Steinbrecher KL, Ohman JW, Bhalla S, Raptis CA. CT of Postoperative Repair of the Ascending Aorta and Aortic Arch. Radiographics 2021; 41:1300-1320. [PMID: 34415808 DOI: 10.1148/rg.2021210026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While many of the classic open surgical repairs are still used to repair the ascending aorta, management of the aortic arch has become more complex via implementation of newer open surgical and endovascular techniques. Furthermore, techniques are often combined in novel repairs or to allow extended anatomic coverage. As such, a framework that rests on understanding the expected postoperative appearance is necessary for the diagnostic radiologist to best interpret CT studies in these patients. After reviewing the imaging appearances of the common components used in proximal aortic repair, the authors present a structured approach that focuses on the key relevant questions that diagnostic radiologists should consider when interpreting CT studies in these patients. For repair of the ascending aorta, this includes determining whether the aortic valve has been repaired, whether the sinuses of Valsalva have been repaired, and how the coronary arteries were managed, when necessary. In repairs that involve the aortic arch, the relevant considerations relate to management of the arch vessels and the distal extent of the repair. In focusing on these questions, the diagnostic radiologist will be able to identify and describe the vast majority of repairs. Understanding these questions will also facilitate improved understanding of novel repairs, which often use these basic building blocks. Finally, complications-which typically involve infection, noninfectious repair breakdown, hemorrhage, problems with endografts, or disease of the remaining adjacent aorta-will be identifiable as deviations from the expected postoperative appearance. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Kaitlin M Marquis
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Muhammad Naeem
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Mohamed Zak Rajput
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Demetrios A Raptis
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Kacie L Steinbrecher
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - J Westley Ohman
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Constantine A Raptis
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
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11
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Post-operative computed tomography imaging evaluation of ascending aorta surgery. Pol J Radiol 2021; 86:e246-e254. [PMID: 34093922 PMCID: PMC8147721 DOI: 10.5114/pjr.2021.105855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/06/2020] [Indexed: 12/01/2022] Open
Abstract
Ascending thoracic aorta disease is often a life-threatening condition. Aortic aneurysm and aortic dissection are the most frequent ascending aorta diseases requiring surgical intervention. Surgical repair techniques of the ascending aorta are various; they include reconstruction of the ascending aorta by using a graft with or without a prosthetic valve, reconstruction with a composite artificial graft or using a biological graft, and reconstruction of the ascending aorta with a composite graft preserving the native valve and arch repair. The radiologist plays a key role in the identification of post-operative complications; differentiation from normal postoperative findings is fundamental. Our aim is to discuss the main diseases affecting the ascending aorta requiring surgery and the different techniques used to treat them. We also discuss the normal computed tomography (CT) imaging findings and after-surgery complications.
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12
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Stein R, Padilla RM, Wynn G. Giant Right Coronary Ostial Aneurysm in a Patient With Marfan Syndrome. Cureus 2021; 13:e13627. [PMID: 33816026 PMCID: PMC8011626 DOI: 10.7759/cureus.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aortic root dilation and aortic insufficiency are prominent causes of morbidity in Marfan syndrome. These pathologies necessitate surgical repair, including aortic root and aortic valve replacement procedures, to improve prognosis. Coronary artery aneurysms, particularly giant coronary ostial aneurysms, are rare complications of these surgeries in the Marfan population. Due to the significant life-threatening sequelae of coronary artery aneurysms, it is imperative to bring attention regarding this complication to the radiologist assessing thoracic imaging in this patient population.
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Affiliation(s)
- Rachel Stein
- Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Rebekah M Padilla
- Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Gregory Wynn
- Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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13
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Lechiancole A, Vendramin I, Sponga S, Piani D, Benedetti G, Meneguzzi M, Ferrara V, Tullio A, Bortolotti U, Livi U. Bentall procedure with the CarboSeal™ and CarboSeal Valsalva™ composite conduits: long-term outcomes. Interact Cardiovasc Thorac Surg 2021; 33:93-100. [PMID: 33598695 DOI: 10.1093/icvts/ivab045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/10/2020] [Accepted: 01/21/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Data on the long-term results with the standard CarboSeal™ mechanical conduit used for the modified Bentall procedure are lacking as well as information on performance of the Valsalva CarboSeal™ conduit. METHODS We have analysed 208 recipients of a standard (n = 110) or a Valsalva (n = 98) CarboSeal™ conduit. The median age was 60 years and 90% were males; 35 (17%) had type A aortic dissection and 65 (30%) a bicuspid aortic valve. Data were retrospectively analysed and results were compared between the 2 conduit models. RESULTS Early mortality was 1.9%; the mean follow-up was 175 ± 95 for standard and 94 ± 51 months for Valsalva conduits (P < 0.01). Actuarial survival was 86 ± 4%, 75 ± 6%, 59 ± 7% and 51 ± 9% at 5, 10, 15 and 20 years, respectively. There were 13 thromboembolic episodes with 3 deaths with an actuarial freedom of 98 ± 1%, 94 ± 2%, 90 ± 3% and 89 ± 4% at 5, 10, 15 and 20 years, respectively. Reoperation on the aortic root was performed in 9 patients for endocarditis (n = 8) and pseudoaneurysm at the right coronary button (n = 1) with an actuarial freedom of 97 ± 1%, 95 ± 2%, 92 ± 3% and 87 ± 4% at 5, 10, 15 and 20 years, respectively. There were no differences between the 2 conduit models in survival and major postoperative complications. CONCLUSIONS The CarboSeal™ conduit has shown gratifying overall performance up to 20 years and appears a valid option for a modified Bentall operation, when a mechanical prosthesis is indicated. Both CarboSeal™ conduit models provided not statistically different overall long-term results.
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Affiliation(s)
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | | | - Matteo Meneguzzi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | | | - Annarita Tullio
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Uberto Bortolotti
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
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14
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Fukui T, Ogasawara N, Hasegawa S. Dynamic kinking of right coronary artery after the button Bentall procedure. BMJ Case Rep 2021; 14:14/1/e239128. [PMID: 33509885 PMCID: PMC7845688 DOI: 10.1136/bcr-2020-239128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Postoperative coronary artery complications after Bentall procedures are well recognised but are rare and potentially fatal. There have been only five cases documenting percutaneous coronary intervention (PCI) for right coronary artery (RCA) involvements after button Bentall procedures. We describe a case of postoperative silent myocardial ischaemia in a 72-year-old man who underwent the button Bentall procedure for a right sinus of Valsalva aneurysm. On postoperative day 15, an RCA complication was incidentally detected by follow-up multidetector CT. Coronary angiography showed proximal RCA kinking, which was not an anastomosis but a native coronary artery. The patient underwent a successful PCI with drug-eluting stent implantation. We reviewed six cases consisting of this case and five previous cases treated with PCI. These cases enhance the recognition of potential RCA complications after the button Bentall procedure.
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Affiliation(s)
- Tomoki Fukui
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Shinji Hasegawa
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
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15
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Krishna H, Ginde S, Katzmark L, Mitchell M, Woods R, Hraska V, Earing MG. Coronary ostial aneurysms following aortic root replacement in patients with familial aortic aneurysm are common and support the need for long-term surveillance. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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De Martino A, Milano AD, Bortolotti U. Use of Pericardium for Cardiac Reconstruction Procedures in Acquired Heart Diseases-A Comprehensive Review. Thorac Cardiovasc Surg 2019; 69:83-91. [PMID: 31604358 DOI: 10.1055/s-0039-1697918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Reconstruction of cardiac structures has been the goal of many surgeons even before the advent of open-heart procedures with cardiopulmonary bypass. Unsatisfactory results with synthetic materials has switched the attention to biological tissues, among which pericardium, either autologous or of animal origin, has been widely used as patch material. METHODS We have reviewed the literature to assess the effective role of pericardial tissue in the correction of various acquired cardiac lesions. Particularly, special attention was given not only to established techniques but also to detect any peculiar and unusual application of pericardium. RESULTS Autologous pericardium is frequently used as patch material particularly when limited valvular lesions must be corrected, while xenograft pericardium appears particularly useful in patients with endocarditis and extensive destruction of the intracardiac structures by infection and abscesses. Pericardium is an extremely versatile material owing to its pliability and strength; however, it tends to calcify in the long term when in contact with blood, although stability of the repair is maintained in most cases. CONCLUSIONS Pericardium plays an important role in various cardiac and aortic pathologies. Tissues resistant to fibrosis and calcification to be used as patch material are the ideal solution for more successful cardiac reconstruction procedures and will hopefully be provided by the ongoing research.
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Affiliation(s)
| | - Aldo D Milano
- Department of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
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17
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Patel MD, Hyde JAJ. Percutaneous Management of Coronary Button Kinking After Emergency Aortic Root Replacement. Ann Thorac Surg 2019; 109:e1-e2. [PMID: 31199899 DOI: 10.1016/j.athoracsur.2019.04.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
Surgical management of type A acute aortic dissection by the Bentall procedure involves attachment of the native coronary arteries to a synthetic valved-graft conduit (mechanical or biological aortic valve). In patients with normal anatomy and with careful surgical technique, formation of coronary buttons has been successful, and anastomotic complications after this procedure are rare. However, we describe the development of postoperative myocardial ischemia in a 46-year-old man caused by coronary button kinking after the Bentall procedure and reflect how one may avoid returning to the operating theater and still achieve a good outcome.
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Affiliation(s)
- Mitul D Patel
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals National Health Service Trust, Sussex, United Kingdom.
| | - Jonathan A J Hyde
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals National Health Service Trust, Sussex, United Kingdom
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18
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Yoshimura K, Tanaka H, Wada T, Shuto T, Kawano M, Anai H, Miyamoto S. True Aneurysm of the Left Main Trunk in a Marfan Syndrome Patient at Remote Period after Bentall Operation and Total Arch Replacement: A Case Report. Ann Thorac Cardiovasc Surg 2019; 27:327-331. [PMID: 31068502 PMCID: PMC8560535 DOI: 10.5761/atcs.cr.18-00081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2002, a 37-year-old male with Marfan syndrome underwent the Bentall operation, total arch replacement, and aortobifemoral bypass for DeBakey type IIIb chronic aortic dissection, annuloaortic ectasia, and aortic regurgitation. In 2007, mild mitral regurgitation (MR) caused by mitral valve prolapse was identified. In April 2017, echocardiography revealed the worsening of MR and moderate tricuspid regurgitation (TR). Moreover, coronary angiography (CAG) revealed a coronary artery aneurysm in the left main trunk (LMT). In August 2017, the patient underwent mitral valve replacement (MVR), tricuspid annuloplasty (TAP), and coronary artery reconstruction. We reconstructed the LMT aneurysm using an artificial graft. True aneurysm of the coronary artery complicated with Marfan syndrome is a rare complication that has seldom been reported. This case highlights that it is essential to carefully follow-up patients with Marfan syndrome after the Bentall operation.
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Affiliation(s)
- Kenshi Yoshimura
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Hideyuki Tanaka
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Tomoyuki Wada
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Takashi Shuto
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Madoka Kawano
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Hirofumi Anai
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Shinji Miyamoto
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
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19
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Garrana S, Martínez-Jiménez S. Postcardiovascular Surgery Findings of the Thoracic Aorta. Radiol Clin North Am 2018; 57:213-231. [PMID: 30454814 DOI: 10.1016/j.rcl.2018.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Various disease processes may affect the ascending thoracic aorta, aortic arch, and/or descending thoracic aorta, including aneurysms, dissections, intramural hematomas, penetrating atherosclerotic ulcers, and aortic transection/rupture. Many of those conditions require surgical intervention for repair. Multiple open and endovascular techniques are used for treatment of thoracic aortic pathology. It is imperative that the cardiothoracic radiologist have a thorough knowledge of the surgical techniques available, the expected postoperative imaging findings, and the complications that may occur to accurately diagnose life-threatening pathology when present, and avoid common pitfalls of misinterpreting normal postoperative findings as pathologic conditions.
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Affiliation(s)
- Sherief Garrana
- Department of Radiology, University of Missouri in Kansas City (UMKC), St Luke's Hospital of Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA.
| | - Santiago Martínez-Jiménez
- Department of Radiology, St Luke's Hospital of Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA
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20
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21
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Delorme S, Ruchat P, Goy JJ. Percutaneous treatment of late complications of the Bentall procedure. Catheter Cardiovasc Interv 2018; 92:348-352. [PMID: 28296051 DOI: 10.1002/ccd.26994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 12/23/2016] [Accepted: 01/28/2017] [Indexed: 11/09/2022]
Abstract
Aortic pseudo-aneurysm following the Bentall procedure is a rare but potentially severe complication. Surgical reintervention represents a high risk. We report on two cases with different pseudo-aneurysm types which were successfully treated using two different percutaneous techniques. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- S Delorme
- Hôpital Cantonal Fribourg, Fribourg, Switzerland
| | - P Ruchat
- Clinique Cecil, Lausanne, Switzerland
| | - J J Goy
- Clinique Cecil, Lausanne, Switzerland
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22
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Tsuji M, Kodera S, Oshima T, Uehara M, Kiyosue A, Ando J, Watanabe M, Yamauchi H, Ono M, Komuro I. Coronary Artery Perforation During Percutaneous Coronary Intervention in a Patient with a Prior Modified Bentall Procedure. Int Heart J 2018; 59:848-853. [DOI: 10.1536/ihj.17-357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Masaki Tsuji
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Arihiro Kiyosue
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Jiro Ando
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masafumi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Haruo Yamauchi
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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23
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Ma WG, Ziganshin BA, Guo CF, Zafar MA, Sieller RS, Tranquilli M, Elefteriades JA. Does BioGlue contribute to anastomotic pseudoaneurysm after thoracic aortic surgery? J Thorac Dis 2017; 9:2491-2497. [PMID: 28932555 DOI: 10.21037/jtd.2017.06.120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although bovine serum albumin-glutaraldehyde glue (BioGlue®) has been successfully used as a hemostatic adjunct in aortic surgical procedures, there are reports that it may lead to anastomotic pseudoaneurysm formation. We seek to examine if the use of BioGlue is associated with a high incidence of anastomotic pseudoaneurysm formation following surgical repair of thoracic aortic disease. METHODS We reviewed the medical records and follow-up computed tomography (CT) scans of patients from 2001 to 2015 in whom BioGlue was used during surgical repair of thoracic aortic disease to detect postoperative anastomotic pseudoaneurysm formation. RESULTS A total of 233 patients with BioGlue use were identified. Mean age was 63.5±14.0 years (median 66; range 14-88; 25-75%, IQR 54-74 years) and 149 were male (63.9%). Surgical indication was thoracic aortic aneurysm in 169 (72.5%) patients, aortic dissection in 49 (21.0%), intramural hematoma in 9 (3.9%), penetrating aortic ulcer in 3 (1.3%) and other in 3 (1.3%). Emergency/urgent surgery was performed in 68 cases (29.2%). Operative mortality was 7.3% (17/233). Re-exploration for bleeding and neurologic deficits occurred in 24 (10.3%) and 21 (9.0%) patients respectively. All operative survivors were followed (100%, 216/216) and CT follow-up was available in 81.9% (177/216) for a mean duration of 2.4 years (median 0.6; 25-75% IQR 0.2-3.6 years). Anastomotic pseudoaneurysm was detected in 1 patient (0.6%) at 3 years postoperatively. This was an elderly female with extremely frail tissues who underwent a reoperative ascending and arch replacement for dissection. CONCLUSIONS The use of BioGlue in thoracic aortic surgery was not associated with excess incidence of anastomotic pseudoaneurysm formation following surgical repair of thoracic aortic disease. Its use need not be discouraged on this basis.
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Affiliation(s)
- Wei-Guo Ma
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.,Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.,Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia
| | - Chang-Fa Guo
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.,Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Richard S Sieller
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Maryann Tranquilli
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
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24
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Rashed A, Gombocz K, Vigh A, Alotti N. Total proximal anastomosis detachment after classical bentall procedure. Int J Surg Case Rep 2017; 37:173-176. [PMID: 28688312 PMCID: PMC5501880 DOI: 10.1016/j.ijscr.2017.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/05/2017] [Accepted: 06/11/2017] [Indexed: 11/28/2022] Open
Abstract
Total proximal anastomosis detachment after classical Bentall procedure is very rare and life-threatrning complication. Elongation of the left ventricle tract may serve a surgical solution to treat this complication. Surgeons performing the Bentall procedure must be familiar with all existing modifications.
Introduction Since its introduction in 1968, the Bentall procedure has been the primary surgical solution for aneurysms of the aortic root. However, many surgeons have reported serious procedural complications such as detachment of coronary ostia and pseudoaneurysm formation at anastomosis sites. Therefore, the Bentall procedure has undergone several modifications to eliminate those complications. Partial or total detachment of the proximal anastomosis is rarely reported. Presentation of case We report a total detachment of the proximal anastomosis after a Bentall operation with emphasis on the possible practical mechanisms, which might have led to the development of this very rare complication. The diagnosis was confirmed at a routine follow up examination and urgent surgery was performed. We also report our operative solution and review other possible surgical solutions that might be considered in this setting. Discussion The Bentall procedure and its modifications continue to be considered the gold standard for treating aneurysms involving the aortic root. Various modifications can serve as optimal solutions for procedure-related complications. Conclusion Surgeons performing the Bentall procedure must be familiar with all existing modifications because they are complementary to the original surgical procedure. In the absence of endocarditis left ventricle outflow tract elongation may be an acceptable surgical solution to deal with total detachment of the proximal anastomosis.
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Affiliation(s)
- Aref Rashed
- Department of Cardiac Surgery, Zala St. Raphael County Hospital, Zalaegerszeg, Hungary.
| | - Karoly Gombocz
- Department of Cardiac Surgery, Zala St. Raphael County Hospital, Zalaegerszeg, Hungary
| | - Andras Vigh
- Department of Cardiac Surgery, Zala St. Raphael County Hospital, Zalaegerszeg, Hungary
| | - Nasri Alotti
- Department of Cardiac Surgery, Zala St. Raphael County Hospital, Zalaegerszeg, Hungary
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25
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Manenti A, Zizzo M, Fedeli C, Caprili L. Coronary Artery Pseudoaneurysm After Bentall Procedure. Ann Thorac Surg 2017; 102:1409. [PMID: 27645951 DOI: 10.1016/j.athoracsur.2016.02.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 02/20/2016] [Accepted: 02/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Antonio Manenti
- Department of Surgery, University of Modena, Policlinico Hospital, via Pozzo, 71, 41124 Modena, Italy.
| | - Maurizio Zizzo
- Department of Surgery, University of Modena, Policlinico Hospital, via Pozzo, 71, 41124 Modena, Italy
| | - Corrado Fedeli
- Department of Surgery, University of Modena, Policlinico Hospital, via Pozzo, 71, 41124 Modena, Italy
| | - Luca Caprili
- Department of Surgery, University of Modena, Policlinico Hospital, via Pozzo, 71, 41124 Modena, Italy
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26
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Mookhoek A, Korteland NM, Arabkhani B, Di Centa I, Lansac E, Bekkers JA, Bogers AJ, Takkenberg JJ. Bentall Procedure: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2016; 101:1684-9. [DOI: 10.1016/j.athoracsur.2015.10.090] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 10/20/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022]
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27
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Benke K, Ágg B, Szabó L, Szilveszter B, Odler B, Pólos M, Cao C, Maurovich-Horvat P, Radovits T, Merkely B, Szabolcs Z. Bentall procedure: quarter century of clinical experiences of a single surgeon. J Cardiothorac Surg 2016; 11:19. [PMID: 26801237 PMCID: PMC4724135 DOI: 10.1186/s13019-016-0418-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 01/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background We retrospectively analyzed 25 years of experiences with the button Bentall procedure in patients with aortic root pathologies. Even though this procedure has become widespread, there are only a few very long term follow-ups available in the clinical literature, especially regarding single surgeon results. Methods Between 1988 and 2013, a total of 147 patients underwent the Bentall procedure by the same surgeon. Among them there were 62 patients with Marfan syndrome. At the time of the surgery the mean age was 46.5 ± 17.6 years. The impact of surgical experience on long-term survival was evaluated using a cumulative sum analysis chart. Results The Kaplan-Meier estimated overall survival rates for the 147 patients were 91.8 ± 2.3 %, 84.3 ± 3.1 %, 76.3 ± 4.9 % and 59.5 ± 10.7 % at 1,5,10 and 20 years, respectively. Multivariate Cox regression analysis identified EuroSCORE II over 3 % (OR 4.245, 95 % CI, 1.739–10.364, p = 0.002), acute indication (OR 2.942, 95 % CI, 1.158–7.480, p = 0.023), use of deep hypothermic circulatory arrest (OR 3.267, 95 % CI, 1.283–8.323, p = 0.013), chronic kidney disease (OR 6.865, 95 % CI, 1.339–35.189, p = 0.021) and early complication (OR 3.134, 95 % CI, 1.246–7.883, p = 0.015) as significant risk factors for the late overall death. The survival rate for freedom from early complication was 94.3 ± 2.2 %, 88.0 ± 3.3 %, 82.9 ± 4.7 % and 69.2 ± 8.4 % at 1,5,10 and 20 years. The main pathological findings of the aortic wall were cystic medial degeneration in 75 %, fibrosis in 6 %, atherosclerosis in 13 % and no pathological alteration in 6 % of the samples. The overall survival rate was significantly lower in patients operated in first 15 years compared to patients operated in the last decade (log-rank p = 0.011). Conclusion According to our long-term follow-up the Bentall operation provides an appropriate functional result by resolving the lesions of the ascending aorta. Based on our results, 25–30 operations done is necessary to gain such a level of confidence and experince to aquire better results on long-term survival. In addition, we discussed that there were no co-morbidities affecting on the survival of Marfan patients and prophylactic aortic root replacement ensures a longer survival among patients with Marfan syndrome.
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Affiliation(s)
- Kálmán Benke
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary. .,Hungarian Marfan Foundation, Budapest, Hungary.
| | - Bence Ágg
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - Lilla Szabó
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.,MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Balázs Odler
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary
| | - Chun Cao
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary
| | - Pál Maurovich-Horvat
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.,MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
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Hanneman K, Chan FP, Mitchell RS, Miller DC, Fleischmann D. Pre- and Postoperative Imaging of the Aortic Root. Radiographics 2016; 36:19-37. [PMID: 26761529 PMCID: PMC4734055 DOI: 10.1148/rg.2016150053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/29/2015] [Accepted: 07/31/2015] [Indexed: 01/02/2023]
Abstract
Three-dimensional datasets acquired using computed tomography and magnetic resonance imaging are ideally suited for characterization of the aortic root. These modalities offer different advantages and limitations, which must be weighed according to the clinical context. This article provides an overview of current aortic root imaging, highlighting normal anatomy, pathologic conditions, imaging techniques, measurement thresholds, relevant surgical procedures, postoperative complications and potential imaging pitfalls. Patients with a range of clinical conditions are predisposed to aortic root disease, including Marfan syndrome, bicuspid aortic valve, vascular Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Various surgical techniques may be used to repair the aortic root, including placement of a composite valve graft, such as the Bentall and Cabrol procedures; placement of an aortic root graft with preservation of the native valve, such as the Yacoub and David techniques; and implantation of a biologic graft, such as a homograft, autograft, or xenograft. Potential imaging pitfalls in the postoperative period include mimickers of pathologic processes such as felt pledgets, graft folds, and nonabsorbable hemostatic agents. Postoperative complications that may be encountered include pseudoaneurysms, infection, and dehiscence. Radiologists should be familiar with normal aortic root anatomy, surgical procedures, and postoperative complications, to accurately interpret pre- and postoperative imaging performed for evaluation of the aortic root. Online supplemental material is available for this article.
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Affiliation(s)
- Kate Hanneman
- From the Joint Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, Munk Building, 1 PMB-298, 585 University Ave, Toronto, ON M5G 2N2 (K.H.) and the Departments of Radiology (K.H., F.P.C., D.F.) and Cardiothoracic Surgery (R.S.M., D.C.M.), Stanford University School of Medicine, Stanford, Calif
| | - Frandics P. Chan
- From the Joint Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, Munk Building, 1 PMB-298, 585 University Ave, Toronto, ON M5G 2N2 (K.H.) and the Departments of Radiology (K.H., F.P.C., D.F.) and Cardiothoracic Surgery (R.S.M., D.C.M.), Stanford University School of Medicine, Stanford, Calif
| | - R. Scott Mitchell
- From the Joint Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, Munk Building, 1 PMB-298, 585 University Ave, Toronto, ON M5G 2N2 (K.H.) and the Departments of Radiology (K.H., F.P.C., D.F.) and Cardiothoracic Surgery (R.S.M., D.C.M.), Stanford University School of Medicine, Stanford, Calif
| | - D. Craig Miller
- From the Joint Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, Munk Building, 1 PMB-298, 585 University Ave, Toronto, ON M5G 2N2 (K.H.) and the Departments of Radiology (K.H., F.P.C., D.F.) and Cardiothoracic Surgery (R.S.M., D.C.M.), Stanford University School of Medicine, Stanford, Calif
| | - Dominik Fleischmann
- From the Joint Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, Munk Building, 1 PMB-298, 585 University Ave, Toronto, ON M5G 2N2 (K.H.) and the Departments of Radiology (K.H., F.P.C., D.F.) and Cardiothoracic Surgery (R.S.M., D.C.M.), Stanford University School of Medicine, Stanford, Calif
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29
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Valenzuela DM, Ordovas KG. Radiologic evaluation of coronary artery disease in adults with congenital heart disease. Int J Cardiovasc Imaging 2015; 32:13-8. [PMID: 26342712 DOI: 10.1007/s10554-015-0760-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 08/29/2015] [Indexed: 12/31/2022]
Abstract
Improved surgical and medical therapy have prolonged survival in patients with congenital heart disease (CHD) such that general medical conditions like coronary artery disease (CAD) are now the main determinants of mortality. A summary of the association of CAD with CHD, as well as a discussion of the radiologic evaluation of the coronary arteries in adults with CHD is described herein. Cross sectional imaging to evaluate CAD in adults with CHD should follow the same appropriateness criteria as gender and aged matched patients without CHD. Coronary CT imaging may be particularly valuable in evaluating the coronary arteries in this patient population as invasive coronary angiography may prove challenging secondary to complicated or unconventional anatomy of the coronary arteries. Further, typical methods for evaluating CAD such as stress or echocardiography may be impractical in adults with CHD. Finally, delineating the anatomic relationship of the coronary arteries and their relationship with the sternum, chest wall, conduits, grafts, and valves is highly recommended in patients with CHD prior to reintervention to avoid iatrogenic complications.
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Affiliation(s)
- David M Valenzuela
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Karen G Ordovas
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA.
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30
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Isomura S, Hosoda S, Shikawa A. Surgery for detached coronary ostial anastomosis 21 years post-Bentall procedure. Heart Vessels 2014; 31:265-7. [PMID: 25252776 DOI: 10.1007/s00380-014-0583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 09/12/2014] [Indexed: 11/26/2022]
Abstract
Though a high frequency of postoperative complications after an original Bentall procedure has been reported, several procedures that reduce the incidence of complications have been developed. Complications relating to anastomoses of the interposed graft are infrequent but life-threatening. This report describes a case of a 61-year-old man who presented with heart failure secondary to bilateral detachment of coronary ostial anastomoses and graft stenosis 21 years after undergoing a modified Bentall procedure. These complications were successfully repaired by reconstructing the conduit and coronary arteries.
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MESH Headings
- Anastomosis, Surgical
- Aneurysm, False/diagnosis
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/surgery
- Aortography/methods
- Blood Vessel Prosthesis Implantation/adverse effects
- Cardiac Surgical Procedures/adverse effects
- Coronary Angiography/methods
- Coronary Artery Bypass
- Coronary Vessels/surgery
- Graft Occlusion, Vascular/diagnosis
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/surgery
- Humans
- Male
- Middle Aged
- Reoperation
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Shogo Isomura
- Department of Cardiac Surgery, Sendai Cardiovascular Center, 21-1 Honda-cho, Izumi-ku, Sendai, Miyagi, 981-3107, Japan.
| | - Susumu Hosoda
- Department of Cardiac Surgery, Sendai Cardiovascular Center, 21-1 Honda-cho, Izumi-ku, Sendai, Miyagi, 981-3107, Japan
| | - Akira Shikawa
- Department of Cardiac Surgery, Sendai Cardiovascular Center, 21-1 Honda-cho, Izumi-ku, Sendai, Miyagi, 981-3107, Japan
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Multidetector CT findings of complications of surgical and endovascular treatment of aortic aneurysms. Radiol Clin North Am 2014; 52:961-89. [PMID: 25173654 DOI: 10.1016/j.rcl.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aortic aneurysms remain a significant problem in the population, and there is a concerted effort to identify, define, image, and treat these conditions to ultimately improve outcomes. The rapid development of diagnostic modalities, operative strategies, and endovascular techniques within the realm of this aortic disease has transformed the field and broadened the spectrum of patients that can be treated with minimally invasive techniques. This investigation has a broad spectrum of normal expected findings that must be differentiated from early or late complications in which intervention is required. In this article, normal and abnormal postoperative and post-TEVAR/EVAR MDCT findings are described.
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Ng ACC, Hanzek D, Kritharides L, Yiannikas J. A novel parasternal transthoracic echocardiographic window for detecting coronary ostial dilation after modified Bentall surgery. Cardiovasc Ultrasound 2013; 11:14. [PMID: 23688292 PMCID: PMC3665738 DOI: 10.1186/1476-7120-11-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 05/16/2013] [Indexed: 11/10/2022] Open
Abstract
Background During the modified Bentall surgery (aortic root replacement), a cuff of native aorta is implanted, together with the coronary ostium, into the aortic graft. Multi-detector computed tomography (MDCT) imaging can accurately assess the coronary ostial anastomosis site post-surgery. In this study, we assessed the feasibility of imaging the coronary ostial anastomosis site using transthoracic echocardiography (TTE). Methods Patients (n = 14, mean age 65 ± 12 years, 79% males) with previous Bentall surgery underwent TTE study, with MDCT (64-slice) as the reference standard. TTE used conventional and novel acoustic windows to interrogate the coronary ostia. Results All coronary ostia (n = 28) were well-visualized with MDCT. The optimum TTE acoustic window for visualizing the coronary ostia was a superiorly positioned parasternal short-axis view with the probe tilted towards the left shoulder, medially angulated for the right coronary artery ostia (RCAos) and laterally angulated for the left main coronary artery (LMAos). In this off-axis position, 10 (71%) LMAos and 13 (93%) RCAos could be visualized. In the conventional parasternal views, only 5 (36%) RCAos and no LMAos could be visualized. TTE underestimated the diameter of the LMAos (10.0 ± 2.4 mm TTE vs. 13.4 ± 2.7 mm MDCT, p = 0.007), but was similar to MDCT for the RCAos (9.8 ± 3.1 mm TTE vs. 11.1 ± 3.2 mm MDCT, p = 0.10). Conclusions We report a novel TTE acoustic window to image the coronary ostia of post-Bentall surgery patients. Although TTE underestimates the left coronary ostium size, recognition of the ostial dilation with TTE appears feasible in most patients. Those that cannot be imaged will require alternative imaging modality such as MDCT.
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Affiliation(s)
- Austin Chin Chwan Ng
- Cardiology Department, Concord Hospital, The University of Sydney, Hospital Road, Concord 2139, NSW, Australia.
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Prescott-Focht JA, Martinez-Jimenez S, Hurwitz LM, Hoang JK, Christensen JD, Ghoshhajra BB, Abbara S. Ascending Thoracic Aorta: Postoperative Imaging Evaluation. Radiographics 2013; 33:73-85. [DOI: 10.1148/rg.331125090] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
PURPOSE We retrospectively analyzed 28 years of experience with the Bentall procedure in patients with aortic valve, aortic root, and ascending aortic disease. MATERIALS AND METHODS Between March 1982 and December 2010, a total of 218 patients underwent the Bentall procedure using a composite valved conduit. The "inclusion technique" was used in 30 patients (13.8%), the "open-button technique" in 181 patients (83.0%), and the Cabrol technique in 7 patients (3.2%). RESULTS The early mortality rate was 5.5% (12/218). The mean follow-up duration was 108.0±81.0 months (range: 1-329 months). Seven patients required re-operation, and 1 patient required stent graft insertion at the descending thoracic aorta for progression of aortic arch or descending thoracic aortic dissection or aneurysm after the first operation, and 5 of them had Marfan syndrome. Kaplan-Meier estimated survival rates at 1, 5, 10, 20, and 25 years were 90.4%, 82.7%, 77.6%, 65.3%, and 60.3%, respectively. Freedom from reoperation rates at 1, 5, 10, 20, and 25 years were 99.0%, 98.3%, 95.5%, 90.8%, and 90.8%, respectively. CONCLUSION In our experience, the Bentall procedure provided optimal survival with improved functional status. The disease of the aorta may progress, especially in patients with Marfan syndrome. Therefore, careful follow-up with regular computed tomography angiograms should be performed in these patients.
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Affiliation(s)
- Hyun-Chel Joo
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Chul Chang
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Nam Youn
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Jong Yoo
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
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Senanayake EL, Cooper GJ. Indirect re-implantation of the left coronary artery during aortic surgery. J Card Surg 2012; 27:205-10. [PMID: 22458276 DOI: 10.1111/j.1540-8191.2012.01421.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Indirect re-implantation of the left coronary artery (LCA) via an interposition graft simplifies difficult LCA re-implantation during aortic root replacement. Little information exists regarding the results of this technique. In this study, we report our experience. METHODS Between January 2001 and July 2008, of 82 aortic root replacements, 24 (mean age 48.2 years, 83% male) used the indirect re-implantation technique. All case notes were retrospectively analyzed. Indications for operation were; aortic root aneurysm (n = 16), acute dissection (n = 6), existent homograft calcification (n = 1), failed Ross procedure (n = 1). Reasons for indirect re-implantation were: difficult LCA mobilization secondary to previous cardiac surgery (n = 7), short left main stem (n = 6), acute dissection (n = 6), adherence to surrounding tissues (n = 5). All patients had yearly CT or MRI follow-up. RESULTS Mechanical and tissue valved conduits were implanted in 22 and two patients, respectively. Ten millimeters (n = 17) or 8 mm (n = 7) Dacron grafts were used for LCA re-implantation. Thirty-day mortality was 12.5%. Postoperative complications were: re-opening for bleeding (n = 2), pericardial effusion (n = 4), renal failure (n = 1). Over a median follow-up of 26 months (range 4 to 81), one developed a false aneurysm at the right coronary artery anastomosis five months postoperatively, which was subsequently repaired. All interposition grafts remained patent on MRI or CT. There were six late deaths. At median follow-up survival rate was 71%. CONCLUSIONS The indirect re-implantation of the LCA during aortic root replacements is a reliable, safe, and effective method in dealing with the LCA in difficult circumstances. Survival at 26 months is equivalent to other series of similar patients.
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Affiliation(s)
- Eshan L Senanayake
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom
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36
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Kovacic JC, Sharma SK, Kini AS. Bilateral coronary ostial stenoses post-bentall procedure causing hemodynamic collapse and requiring mechanical assist device placement: Successful intervention using the Szabo technique. Catheter Cardiovasc Interv 2011; 79:801-4. [DOI: 10.1002/ccd.23132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 03/13/2011] [Indexed: 11/09/2022]
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37
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Lusini M, Pollari F, Chello M, Covino E. Right Coronary Ostial Aneurysm Following a Bentall Procedure. J Card Surg 2011; 26:632-3. [DOI: 10.1111/j.1540-8191.2011.01319.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Hashimoto W, Hashizume K, Ariyoshi T, Taniguchi S, Miura T, Odate T, Matsukuma S, Hisatomi K, Eishi K. Ten years experience of aortic root replacement using a modified bentall procedure with a carrel patch and inclusion technique. Ann Vasc Dis 2011; 4:32-6. [PMID: 23555424 DOI: 10.3400/avd.oa.10.00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/01/2010] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE A modified Bentall procedure with a Carrel patch and inclusion technique (Modified Bentall Procedure) has been used to treat combined disease of the aortic valve and aortic root. The current study examined the outcomes of this surgical technique. MATERIALS AND METHODS Between April 1999 and March 2009, 16 patients (10 males, 6 females; 63.3 ± 9.4 years) underwent elective surgery involving the Modified Bentall Procedure and no additional surgery, so they were included in the study. RESULTS The mean cardiopulmonary bypass time was 140.2 ± 34.4 min (range: 97-232 min), and aortic cross-clamp time was 97.3 ± 16.6 min (range: 76-132 min). There were no hospital deaths. No patients required additional surgery to correct excessive bleeding. The follow-up rate was 100% (16/16). The mean follow-up period was 5.6 ± 2.8 years (range: 0.7-9.9 years). One of the 16 patients died (6.3%) due to lung cancer, and 1 of the 15 surviving patients required additional surgery (6.7%) for a thoracic aortic aneurysm. Kaplan-Meier analysis found that 1-year and 5-year survival and event-free survival rates were all 100%. CONCLUSIONS The Modified Bentall Procedure provided satisfactory results over both the short term and long term.
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Affiliation(s)
- Wataru Hashimoto
- Graduate School of Biomedical Science Division of Cardiovascular Surgery, Nagasaki University, Nagasaki, Nagasaki, Japan
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Mukhaini M, Panduranga P. Percutaneous coronary intervention of a saphenous vein graft ostial stenosis in a patient with Bentall procedure. J Saudi Heart Assoc 2010; 22:215-7. [PMID: 23960623 DOI: 10.1016/j.jsha.2010.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 06/20/2010] [Indexed: 10/19/2022] Open
Abstract
Composite graft replacement of the aortic root and coronary reimplantation with or without coronary artery bypass surgery is the standard treatment for a variety of aortic root pathologies. Previously, percutaneous coronary intervention of either reimplanted coronary arteries or left/right coronary artery through cabrol graft has been described in post-Bentall patients. We describe percutaneous coronary intervention of a saphenous vein graft ostial stenosis in a patient with previous Bentall procedure and a vein graft to right coronary artery, which was complex and challenging.
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A Simple Technique to Reduce Tension on Coronary Button Anastomosis in Aortic Root Surgery. Ann Thorac Surg 2010; 90:325-6. [DOI: 10.1016/j.athoracsur.2009.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 07/14/2009] [Accepted: 08/25/2009] [Indexed: 11/22/2022]
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Chwan Ng AC, Yiannikas J, Chiang Yong AS, Ridley L, Wilson MK, Kritharides L. Coronary ostial morphology after modified Bentall operation assessed with dual-source multidetector computed tomography. J Cardiovasc Comput Tomogr 2010; 4:206-12. [PMID: 20413365 DOI: 10.1016/j.jcct.2010.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 01/03/2010] [Accepted: 03/09/2010] [Indexed: 11/15/2022]
Abstract
During the modified Bentall operation (aortic root replacement), a cuff of native aorta is commonly implanted together with the coronary ostium into the aortic graft. We describe the radiologic appearance on computed tomography of coronary-aortic and aorto-aortic graft anastomoses over long-term follow-up in 21 consecutive asymptomatic patients (mean age, 67 +/- 12 years) with previous Bentall operation. Multidetector (64-slice, dual-source) computed tomography was performed at a median of 76 months after surgery. One patient had asymptomatic aortic dissection that extended into the carotid artery. Seven patients had aortic dilation > or =40 mm distal to the graft. All patients had dilation at the postsurgical coronary ostia-aortic attachment: mean coronary ostial diameter was 12.8 +/- 3.6 mm, which was on average 1.7-fold greater than the adjacent proximal coronary vessel diameter. All patients had at least one ostium > or =10 mm in diameter. In 16 patients, both coronary ostia were > or =10 mm. There was no relationship between time after surgery and the ostial diameter. In patients with accessible presurgery angiograms, no relationship was observed between ostial diameters before and after surgery. Dilation of the coronary ostia anastomosis site is typical after the modified Bentall operation. Asymptomatic aortic pathology is also evident in this population.
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Affiliation(s)
- Austin Chin Chwan Ng
- Cardiology Department, Concord Hospital, The University of Sydney, Hospital Road, Concord 2139, NSW, Australia
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42
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Baxt WG. Sudden death from acute thromboembolic occlusion of the left coronary ostium. Am J Emerg Med 2010; 27:1172.e1-3. [PMID: 19931785 DOI: 10.1016/j.ajem.2009.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/09/2009] [Indexed: 11/30/2022] Open
Abstract
The patient was a 55-year-old woman who experienced anterior chest pain after drinking a cup of coffee. The patient had no risk factor for cardiac disease other than mild non- insulin-dependent diabetes mellitus. The patient did have a history of asthma and was on a steroid taper, taking 20 mg of prednisone daily. The patient's physical examination results were within normal limits. Her laboratory data were normal, except for a glucose level of 499 mg/dl and a urinalysis revealing more than 4+ glucose with large ketones. Venous blood gas pH was 7.36, and troponin I, creatinine kinase-MB, electrocardiogram, and chest film were normal. The patient was admitted to rule out acute coronary syndrome. During the placement into an inpatient bed, the patient sustained a cardiac arrest with a narrow complex ventricular rhythm without pulse, from which she could not be resuscitated. The postmortem examination of the lungs revealed no evidence of thromboemboli. The coronary arteries revealed mild atherosclerosis. Examination of the aortic root revealed complete occlusion of the left coronary ostium by a large premortem nonorganized fresh thromboembolus, which was easily removed by passing a probe retrograde from the left main coronary artery (Fig. 1). Microscopically, there were also small thromboemboli in both the distal right and left coronary intramyocardial vessels. An extensive search of the heart and all major vessels was undertaken to identify the source of the possible thromboemboli, and none could be identified. A Medline search of the literature revealed no other similar case.
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Affiliation(s)
- William Gordon Baxt
- Department of Emergency Medicine, Ground Ravdin, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
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Knight J, Baumüller S, Kurtcuoglu V, Turina M, Turina J, Schurr U, Poulikakos D, Marshall W, Alkadhi H. Long-term follow-up, computed tomography, and computational fluid dynamics of the Cabrol procedure. J Thorac Cardiovasc Surg 2009; 139:1602-8. [PMID: 19913239 DOI: 10.1016/j.jtcvs.2009.09.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 09/04/2009] [Accepted: 09/17/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The Cabrol procedure is characterized by insertion of an ascending aortic composite graft with reimplantation of the coronary arteries by the interposition of a graft tube. Our purpose is to report the clinical long-term follow-up and computed tomographic findings in patients having undergone the Cabrol procedure and to determine blood flow in the Cabrol graft using computational fluid dynamics. METHODS Clinical follow-up (76.6 +/- 16.6 months) and dual-source computed tomographic angiography data of 7 patients (all men, mean age 54.9 +/- 9.6 years) with 12 Cabrol grafts (left main coronary artery, n = 7; right coronary artery, n = 5) were reviewed. In 2 patients, the right coronary artery was directly reattached to the aortic graft. Computational fluid dynamics were calculated using computed tomographic data of a patient with the Cabrol procedure and compared with those in a Valsalva graft and a healthy aortic root. RESULTS Computed tomography showed Cabrol graft occlusions to 1 of 7 (14%) left main and of 2 of 5 (40%) right coronary arteries. Six grafts to the left main and 3 to the right coronary artery were fully patent, similar to the 2 directly reattached right coronary arteries to the aortic graft. Computational fluid dynamics results show similar blood flow parameters into the coronaries for the healthy aortic root and Valsalva graft. In the Cabrol graft, a spiraling flow pattern with low flow into the right coronary artery was found (right coronary artery = 1 mL/min at both systole and diastole). CONCLUSIONS Our study indicates low flow rates particularly in the right Cabrol graft correlating with a higher incidence of occlusions of the right as compared with the left Cabrol graft at long-term follow-up.
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Affiliation(s)
- Joseph Knight
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland
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Nakahira A, Shibata T, Sasaki Y, Hirai H, Hattori K, Hosono M, Ehara S, Suehiro S. Outcome after the modified Bentall technique with a long interposed graft to the left coronary artery. Ann Thorac Surg 2009; 87:109-15. [PMID: 19101281 DOI: 10.1016/j.athoracsur.2008.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 10/07/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The modified Bentall technique, which was reported by Svensson in 1992, is an aortic root composite valve graft replacement involving reimplantation of the left coronary ostium with a long interposed graft wrapping behind the composite graft. The technique is technically advantageous, particularly for complicated or redo aortic roots. To justify the technique, the midterm outcome needs to be evaluated. METHODS Since 1992, 40 patients (4 with Marfan syndrome) underwent the modified Bentall technique (Svensson's modification). The mean age was 54.7 +/- 13.6 years, and 32 patients (80.0%) were male. All hospital survivors have been consecutively followed with annual echocardiographic evaluations. Furthermore, in 2007, multislice computed tomography was performed at 4.7 +/- 3.5 years (maximum, 14.9 years) postoperatively in 30 patients who had preserved renal function. RESULTS No patients have experienced any complications regarding the technique at the follow-up of 5.7 +/- 4.0 years (maximum, 14.9 years), although there were 2 hospital deaths of emergency cases and 5 late deaths owing to noncardiac causes. In 35 patients (92.1% of hospital survivors), no structural complications were detected by multislice computed tomographies of the 30 patients or coronary angiograms of the remaining 5 patients. The consecutive echocardiographic follow-ups showed well-preserved left ventricular function with the most recent ejection fraction being 0.581 +/- 0.078. CONCLUSIONS This Svensson's modification technique was associated with favorable midterm outcomes by multislice computed tomography and consecutive echocardiographic evaluations, indicating long-lasting advantages as well as technical benefits. Thus, the technique can be considered as a helpful and justifiable alternative method.
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Affiliation(s)
- Atsushi Nakahira
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
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45
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Okamoto K, Casselman FP, De Geest R, Vanermen H. Giant left coronary ostial aneurysm after modified Bentall procedure in a Marfan patient. Interact Cardiovasc Thorac Surg 2008; 7:1164-6. [DOI: 10.1510/icvts.2008.183103] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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46
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Bovolato FE, Isabella G, Rampazzo D, Guglielmi C, Gerosa G, Iliceto S, Bilato C. Acute coronary syndrome in a patient with Marfan syndrome following emergent surgical repair of aortic dissection. J Cardiovasc Med (Hagerstown) 2008; 9:615-21. [DOI: 10.2459/jcm.0b013e3282f21689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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47
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Nezic D, Cirkovic M, Knezevic A, Jovic M. Modified Bentall procedure - 'a collar technique' to control bleeding from coronary ostia anastomoses. Interact Cardiovasc Thorac Surg 2008; 7:709-11. [PMID: 18477601 DOI: 10.1510/icvts.2008.180745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Composite conduit aortic root replacement has become widely accepted as the preferred treatment for ascending aorta aneurysm and dissection. We present a patient in whom creation of 'buttons' was impossible due to fragility of the ascending aorta wall. The distal anastomosis was made to the transected aorta. The remnant of the proximal ascending aortic wall was fully transected 8-9 mm above the upper edge of coronary ostia anastomoses (incorporated into conduit using inclusion technique), thus forming a 'collar' around the proximal part of the conduit. At the end of the procedure the 'collar' was anchored to the conduit to control persistent bleeding from coronary ostia anastomoses.
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Affiliation(s)
- Dusko Nezic
- Dedinje Cardiovascular Institute, Belgrade, Serbia.
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48
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Abstract
Marfan syndrome (MFS) is the most common inherited disorder of connective tissue that affects multiple organ systems. This autosomal-dominant condition has an incidence of 2-3 per 10,000 individuals. Although genetic testing is available, the diagnosis is still primarily made using the Ghent criteria. Early identification and appropriate management is critical for patients with MFS who are prone to the life-threatening cardiovascular complications of aortic dissection and rupture. Advances in the understanding of the cause of MFS, early recognition of the disorder, and subsequent institution of medical and surgical therapy has resulted in dramatic improvement in the prognosis of this patient population over the past few decades. Beta-blockers have been demonstrated to slow aortic growth and thus delay the time to aortic surgery. Operative intervention has markedly changed the prognosis of patients with MFS and can be safely performed on an elective basis. Identification of presymptomatic patients is critical to reduce the frequency of catastrophic aortic events.
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Affiliation(s)
- Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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49
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Brat R, Danek T, Maly V. Combination of two pseudoaneurysms in a patient 6 years after ascending aorta and aortic valve replacement. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2007; 151:125-7. [PMID: 17690755 DOI: 10.5507/bp.2007.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We report successful treatment of a patient 6 years after ascending aorta and aortic valve replacement suffering from a combination of two pseudoaneurysms. The first of them originated from the coronary ostial suture line and the second pseudoaneurysm originated from the distal suture line. METHODS We performed re-replantation of the left main trunk to the prosthesis and then we resected the pseudoaneurysm originating from the distal suture line and we replaced the entire aorta by a vascular graft. RESULTS The postoperative convalescence was uneventful, the patient was discharged two weeks after the surgery. The patient is currently in a very good condition one year after the surgery. CONCLUSIONS Coronary ostial pseudoaneurysm in patients after ascending aorta and aortic valve replacement with the use of "button technique" is a quite rare situation. The combination of two pseudoaneurysms originating from different suture lines in one patient seems to be unique in literature reviews.
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Affiliation(s)
- Radim Brat
- Department of Cardiac Surgery, University Hospital Ostrava, Czech Republic.
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Canosa C, Nasso G, De Filippo CM, Spatuzza P, Testa N, Alessandrini F. The "Button Inside" Technique for the Aortic Root Replacement: A Modified Button Technique. J Card Surg 2006; 21:407-9. [PMID: 16846423 DOI: 10.1111/j.1540-8191.2006.00256.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Modified button technique for reattachment of coronary arteries in the aortic root replacement is reported. Anastomosis of the coronary buttons is performed from the inside of the composite valve graft previously including the coronary buttons in the composite valve graft. Reduced tension is present between coronary arteries and the composite valve graft once the heart is beating and the systemic pressure is increasing. In this way coronary buttons are reinforced directly by the composite aortic wall graft prosthesis. The coronary ostia are perfused with lower tension at the site of the coronary anastomoses. No bleeding from the suture line of the coronary buttons occurs using this new surgical approach.
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Affiliation(s)
- Carlo Canosa
- Cardiovascular Department, Catholic University of Sacred Heart, Campus of Campobasso, C.da Tappino-86100, Campobasso, Italy
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