A Pulsatile Chest Mass After Bentall Procedure: A Case Report
Keywords:Aortic valve replacement, Aortic dissection, Bentall procedure
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.
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.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).