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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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Jo JJ, Kim YS, Kim GJ, Kim JH. True Aneurysm of the Common Coronary Button in a Marfan Patient with an Anomalous Right Coronary Artery after a Bentall Procedure: A Case Report. J Chest Surg 2022; 55:243-245. [PMID: 35638121 PMCID: PMC9178298 DOI: 10.5090/jcs.22.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/14/2022] [Accepted: 04/10/2022] [Indexed: 11/16/2022] Open
Abstract
True aneurysms of the coronary artery after aortic root replacement in Marfan syndrome patients are very rare. An anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva adds complexity during aortic root surgery. We present a case of a 37-year-old male patient with Marfan syndrome who had an RCA anomaly and a 4.5-cm true aneurysm of the common coronary button 14 years after a previous Bentall procedure. A redo Bentall operation and hemi-arch replacement were successfully performed. The anomalous origin of the RCA from the left sinus of Valsalva was safely divided and anastomosed as separate coronary buttons to the prosthetic composite valve graft. To prevent coronary button aneurysms after aortic root surgery in Marfan patients, the coronary buttons and the corresponding side holes on the prosthetic graft must be reduced to the maximum possible extent.
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Affiliation(s)
- Jeong Jun Jo
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Yun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Gun-Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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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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Kobayashi K, Kuroda Y, Mizumoto M, Yamashita A, Ohba E, Nakai S, Ochiai T, Uchida T. Left coronary button aneurysm presenting with progressive enlargement after aortic root replacement. J Cardiothorac Surg 2021; 16:250. [PMID: 34488827 PMCID: PMC8422648 DOI: 10.1186/s13019-021-01645-1] [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: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background Aneurysmal degeneration of the coronary button after aortic root replacement using the button technique is a rare but potentially life-threatening complication. However, the appropriate management of this complication, including the indications for conservative and surgical treatment, is still unknown. Case presentation Here we present a 38-year-old woman who successfully underwent surgical repair of a left coronary button aneurysm using the graft interposition technique 24 years after aortic root replacement. Because follow-up computed tomography after aortic root replacement showed a progressively enlarging left coronary button aneurysm, the patient was judged an acceptable candidate for surgical treatment, considering the potential risk of aneurysmal rupture and subsequent myocardial infarction. The postoperative recovery was uneventful. The patient is doing well 1 year after the surgery. Conclusions We believe that serial follow-up using computed tomography is mandatory for coronary button aneurysms, and surgical intervention may be considered if progressive enlargement of the aneurysm is observed, especially in younger patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01645-1.
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Affiliation(s)
- Kimihiro Kobayashi
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Yoshinori Kuroda
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Masahiro Mizumoto
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Atsushi Yamashita
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Eiichi Ohba
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Shingo Nakai
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tomonori Ochiai
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tetsuro Uchida
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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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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Saku K, Takagi K, Fukuda T, Tayama E, Tanaka H. Short-segment coronary artery bypass grafting using radial artery to repair bilateral coronary ostial aneurysms after aortic root replacement in a patient with Marfan syndrome. J Card Surg 2021; 36:3399-3401. [PMID: 34053120 DOI: 10.1111/jocs.15684] [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: 12/27/2020] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
Coronary ostial aneurysm is a complication of aortic root replacement, particularly in Marfan syndrome. Reconstructing the coronary artery is an important problem during reoperation. Herein, we report a case of coronary artery bypass grafting using radial artery to repair bilateral coronary ostial aneurysms after aortic root replacement in a patient with Marfan syndrome.
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Affiliation(s)
- Kosuke Saku
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Kazuyoshi Takagi
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Tomofumi Fukuda
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Eiki Tayama
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Hiroyuki Tanaka
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
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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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Raju SN, Shaw M, Pandey NN, Sharma A, Kumar S. Imaging evaluation using computed tomography after ascending aortic graft repair. Asian Cardiovasc Thorac Ann 2020; 29:132-142. [PMID: 32957798 DOI: 10.1177/0218492320960331] [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] [Indexed: 11/17/2022]
Abstract
Prosthetic aortic graft repair is employed in the management of various conditions such as annuloaortic ectasia, ascending aortic aneurysm, type A aortic dissection, and aortic root abscess. Correct interpretation of post-surgical prosthetic graft complications requires familiarity with the expected normal cross-sectional imaging appearance as well knowledge of additional surgical materials used in the repair, which could influence the imaging appearance. Multiple life-threatening complications of a prosthetic ascending aortic graft can be seen in the aorta and vicinity of the operative field. Complications can arise from involvement of the prosthetic aortic graft per se or secondary involvement of the coronary arteries, mediastinum, and sternotomy site. The optimal imaging protocol using multidetector computed tomography allows accurate interpretation of the expected benign postoperative changes as well as complications associated with the prosthetic graft, and differentiation of true complications from their mimickers. This review focuses on the normal imaging appearance of a prosthetic aortic graft on multidetector computed tomography, and imaging evaluation of multiple post-surgical complications that could arise after repair of the ascending aorta and the aortic valve.
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Affiliation(s)
- Sreenivasa Narayana Raju
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Shaw
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Green DB, Vargas D, Reece TB, Raptis CA, Johnson WR, Truong QA. Mimics of Complications in the Postsurgical Aorta at CT. Radiol Cardiothorac Imaging 2019; 1:e190080. [PMID: 33778523 DOI: 10.1148/ryct.2019190080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/15/2019] [Accepted: 07/26/2019] [Indexed: 01/09/2023]
Abstract
Various surgical techniques of the aorta result in expected imaging appearances on CT images that resemble complications such as pseudoaneurysm, perigraft abscess, and dissection. Awareness of these techniques, understanding the clinical situation in which they are performed, and familiarity with the typical appearances and locations of these mimics are essential for accurate interpretation. CT imaging techniques such as electrocardiographic gating and inclusion of a precontrast series can help distinguish an expected postsurgical finding from a complication. Information in the medical record, particularly the operative note, can clarify challenging cases with unusual imaging features. This review article provides examples of expected postsurgical findings at CT mimicking complications. © RSNA, 2019.
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Affiliation(s)
- Daniel B Green
- Departments of Radiology (D.B.G., D.B.V.) and Surgery (T.B.R.), University of Colorado School of Medicine, 12401 E 17th St, Mailstop L954, Aurora, CO 80045; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.R.); Premier Radiology, Tupelo, Miss (W.R.J.); and Department of Radiology, Weill Cornell Medicine, New York, NY (Q.A.T.)
| | - Daniel Vargas
- Departments of Radiology (D.B.G., D.B.V.) and Surgery (T.B.R.), University of Colorado School of Medicine, 12401 E 17th St, Mailstop L954, Aurora, CO 80045; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.R.); Premier Radiology, Tupelo, Miss (W.R.J.); and Department of Radiology, Weill Cornell Medicine, New York, NY (Q.A.T.)
| | - T Brett Reece
- Departments of Radiology (D.B.G., D.B.V.) and Surgery (T.B.R.), University of Colorado School of Medicine, 12401 E 17th St, Mailstop L954, Aurora, CO 80045; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.R.); Premier Radiology, Tupelo, Miss (W.R.J.); and Department of Radiology, Weill Cornell Medicine, New York, NY (Q.A.T.)
| | - Constantine A Raptis
- Departments of Radiology (D.B.G., D.B.V.) and Surgery (T.B.R.), University of Colorado School of Medicine, 12401 E 17th St, Mailstop L954, Aurora, CO 80045; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.R.); Premier Radiology, Tupelo, Miss (W.R.J.); and Department of Radiology, Weill Cornell Medicine, New York, NY (Q.A.T.)
| | - W Russell Johnson
- Departments of Radiology (D.B.G., D.B.V.) and Surgery (T.B.R.), University of Colorado School of Medicine, 12401 E 17th St, Mailstop L954, Aurora, CO 80045; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.R.); Premier Radiology, Tupelo, Miss (W.R.J.); and Department of Radiology, Weill Cornell Medicine, New York, NY (Q.A.T.)
| | - Quynh A Truong
- Departments of Radiology (D.B.G., D.B.V.) and Surgery (T.B.R.), University of Colorado School of Medicine, 12401 E 17th St, Mailstop L954, Aurora, CO 80045; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.R.); Premier Radiology, Tupelo, Miss (W.R.J.); and Department of Radiology, Weill Cornell Medicine, New York, NY (Q.A.T.)
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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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Prevalence and Natural History of Coronary Ostial Aneurysms in Marfan Patients. J Comput Assist Tomogr 2019; 43:115-118. [DOI: 10.1097/rct.0000000000000799] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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14
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Jiang LC, Cao JY, Chen M. Coronary artery aneurysm combined with other multiple aneurysms at multiple locations: A case report and systematic review. Medicine (Baltimore) 2017; 96:e9230. [PMID: 29390352 PMCID: PMC5815764 DOI: 10.1097/md.0000000000009230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coronary artery aneurysm (CAA) with concomitant aneurysms at multiple sites is quite unusual and rare. The characteristics and the etiology of this phenomenon are unknown. METHODS Herein, we present a case with right coronary aneurysm with concomitant abdominal aorta as well as right renal artery aneurysm. A systematic review of the literatures regarding CAA with other coexisting aneurysms at multiple locations was also conducted on Medline and Embase databases. RESULTS A total of 76 patients (male gender: 58; age: 37.4 ± 26.5) including the present case were included in the final study. The most common etiology of CAA with multiple aneurysms was Kawasaki (43.3%) and atherosclerotic disease (16.4%). CAA was the most frequently found at the right coronary artery (62.7%), following, left anterior descending (51%), left main (43.1%), and left circumflex (35.3%). The most common concomitant aneurysms were abdominal aorta (52.6%) and iliac artery (50%). In addition, 60.5% of the patients had an involved bilateral peripheral artery. CONCLUSION CAA with coexisting systemic aneurysms in multiple sites is quite rare. And it usually involves multiple aneurysms at the coronary and bilateral peripheral arteries simultaneously. Currently, there are no general consensus regarding the clinical characteristics, diagnostic method, and treatment of these cases.
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Giant Coronary Aneurysms: A Rare Complication Following Bentall Procedure. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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Bockeria LA, Malashenkov AI, Rychin SV. eComment: Giant left coronary ostial aneurysm after modified Bentall procedure in a Marfan patient. Interact Cardiovasc Thorac Surg 2008; 7:1166. [PMID: 19029393 DOI: 10.1510/icvts.2008.183103b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Leo A Bockeria
- Bakoulev Center for Cardiovascular Surgery, Moscow, Russia
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Matt P, Eckstein F. eComment: Stabilizing aortic tissue after aortic root surgery in Marfan syndrome. Interact Cardiovasc Thorac Surg 2008; 7:1166. [PMID: 19029394 DOI: 10.1510/icvts.2008.183103a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Peter Matt
- Division of Cardiac Surgery, Basel, Switzerland
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