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Heart, Lung and Circulation

Multiple Anastomotic Dehiscences After the Bentall Procedure for Aortitis Syndrome

Published:August 27, 2022DOI:https://doi.org/10.1016/j.hlc.2022.07.020
      A 53-year-old man with aortitis was transferred to the current hospital for severe cardiogenic shock. He had undergone the Bentall procedure for annulo-aortic ectasia at the age of 30 years and had received steroid therapy following the diagnosis of aortitis. The preoperative 12-lead electrocardiogram showed ST-segment elevation in lead aVR with diffuse ST-segment depression, suggesting coronary malperfusion. Computed tomography (CT) images demonstrated a retrosternal super-giant pseudoaneurysm (Figure 1A-C) and dehiscence of the distal end of the composite graft from the native aorta (Figure 1B). Additionally, preoperative CT images showed that the interposed graft for reconstruction of the left coronary artery was intact, while the continuity of the right coronary artery (RCA) with the composite graft could not be confirmed, suggesting dehiscence of the RCA as well (Figure 1C).
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      Figure 1Computed Tomography (CT) Images. (A) Preoperative three-dimensional reconstructed CT image showing a super-giant aortic pseudoaneurysm. (B) Preoperative axial CT image showing the dehiscence of the distal end of the composite graft from the native aorta. (C) Preoperative sagittal CT image showing that the interposed graft for reconstruction of the left coronary artery was intact, while the continuity of the right coronary artery with the composite graft could not be confirmed. (D) Postoperative three-dimensional reconstructed CT image showing a successful pseudoaneurysm repair.
      Abbreviations: LCA, left coronary artery; RCA, right coronary artery.

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