A Pulsatile Chest Mass After Bentall Procedure: A Case Report

Authors

  • Xiaofan Huang Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • Dashuai Wanga Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • Yu Songa Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • Long Wua Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

DOI:

https://doi.org/10.1532/hsf.4033

Keywords:

Aortic valve replacement, Aortic dissection, Bentall procedure

Abstract

Aortic dissection is an aggressive and life-threatening cardiac disease that’s highly challenging in surgical operation. Bentall procedure comes with potential complications. How to manage these complications is important when it comes to improving patient outcome. In this case, we present a 41-year-old male patient with iatrogenic aortic dissection. He had aortic valve replacement and repair of an atrial septal defect in 2012. After five years, he suffered reoperation for aortic dissection. A year later, the patient was readmitted for a voluminous pulsatile mass over the anterior thorax, confirming the presence of a huge pseudoaneurysm originating from the left coronary bottom performed during the Bentall procedure. This required a third operation to repair the hemorrhagic site. Pseudoaneurysm is a common complication after the inclusion technique in the Bentall procedure. Effective hemostasis or tension-free anastomosis is important toward improving patient outcome.

References

Bossone E, Labounty TM, Eagle KA. 2018. Acute aortic syndromes: diagnosis and management, an update. Eur. Heart J. 39(9):739-749.

Cabrol C, Pavie A, Gandjbakhch I, et al. 1981. Complete replacement of the ascending aorta with reimplantation of the coronary arteries: new surgical approach. J Thorac Cardiovasc Surg 81(2):309-315.

Erbel R, Aboyans V, Boileau C, et al. 2014. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur. Heart J. 35(41):2873-2926.

Gudbjartsson T, Ahlsson A, Geirsson A, et al. 2020. Acute type A aortic dissection - a review. Scand. Cardiovasc. J. 54(1):1-13.

Karangelis D, Tzertzemelis D, Demis AA, et al. 2018. Eighteen years of clinical experience with a modification of the Bentall button technique for total root replacement. J Thorac Dis 10(12):6733-6741.

Mills NL, Morgenstern DA, Gaudiani VA, et al. 1996. "Legs" technique for management of widely separated coronary arteries during ascending aortic repair. Ann. Thorac. Surg. 61(3):869-874.

Niederhauser U, Rudiger H, Vogt P, et al. 1998. Composite graft replacement of the aortic root in acute dissection. Eur J Cardiothorac Surg 13(2):144-150.

Nunez-Gil IJ, Bautista D, Cerrato E, et al. 2015. Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures. Circulation 131(24):2114-2119.

Panos A, Amahzoune B, Robin J, et al. 2001. Influence of technique of coronary artery implantation on long-term results in composite aortic root replacement. Ann. Thorac. Surg. 72(5):1497-1501.

Pham N, Zaitoun H, Mohammed TL, et al. 2012. Complications of aortic valve surgery: manifestations at CT and MR imaging. Radiographics 32(7):1873-1892.

Piehler JM, Pluth JR. 1982. Replacement of the ascending aorta and aortic valve with a composite graft in patients with nondisplaced coronary ostia. Ann. Thorac. Surg. 33(4):406-409.

Raanani E, David TE, Dellgren G, et al. 2001. Redo aortic root replacement: experience with 31 patients. Ann. Thorac. Surg. 71(5):1460-1463.

Sabe AA, Percy E, Kaneko T, et al. 2020. When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review. Ann. Thorac. Surg.

von Kodolitsch Y, Loose R, Ostermeyer J, et al. 2000. Proximal aortic dissection late after aortic valve surgery: 119 cases of a distinct clinical entity. The Thoracic and cardiovascular surgeon 48(6):342.

Westaby S, Katsumata T, Vaccari G. 2000. Aortic root replacement with coronary button re-implantation: low risk and predictable outcome. Eur J Cardiothorac Surg 17(3):259-265.

Published

2021-09-09

How to Cite

huang, xiaofan, Wanga, D., Songa, Y., & Wua, L. (2021). A Pulsatile Chest Mass After Bentall Procedure: A Case Report. The Heart Surgery Forum, 24(5), E794-E796. https://doi.org/10.1532/hsf.4033

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