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[Modified Bentall's operation necessitating coronary artery bypass grafting: a case report]
K Matsuzaki1, R Seino, K Yasuda
1Department of Cardiovascular Surgery, Oji General Hospital, Tomakomai, Japan.
Insights
Severe calcification around the coronary ostia during aortic root aneurysm surgery may necessitate coronary artery bypass grafting (CABG). This surgical consideration ensures optimal blood flow to the heart in complex aortic root repair cases.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Surgery
Background:
- Aortic root aneurysms pose significant surgical challenges, particularly when associated with coronary ostia pathology.
- Modified Bentall's operation is a standard procedure for aortic root aneurysm repair.
Observation:
- Preoperative imaging revealed an aortic root aneurysm involving the right and noncoronary Valsalva sinuses with calcification near the right coronary ostia.
- Intraoperative findings showed severe atherosclerotic changes around the right coronary ostia, including intimal thickening, calcification, and partial intimal defects, despite the ostia being patent.
Findings:
- The patient underwent a modified Bentall's operation.
- Coronary artery bypass grafting (CABG) using a saphenous vein graft was required for right coronary artery reconstruction due to severe atherosclerotic changes.
- The Piehler technique was employed for the left coronary artery.
Implications:
- Preoperative identification of coronary ostia calcification is crucial for planning complex aortic root surgeries.
- Coronary artery bypass grafting may be a necessary adjunct to modified Bentall's operation when significant atherosclerotic disease affects the coronary ostia.
- This approach can ensure successful outcomes and prevent perioperative coronary complications in patients with aortic root aneurysms and coronary artery disease.
Abstract:
A 67-year-old man was admitted to our hospital for the treatment of the aortic root aneurysm. Preoperative chest computed tomography revealed that the aneurysm was located mainly at the right and noncoronary Valsalva sinus with calcification around the right coronary ostia. Modified Bentall's operation was performed. The right coronary ostia was patent. However, atherosclerotic change was severe around the ostia showing intimal thickness, calcification, and partial defect of intima. Coronary artery bypass grafting (CABG) using saphenous vein was performed for the reconstruction of the right coronary artery. Piehler technique was used for the left coronary artery. The postoperative course was uneventful. When the preoperative examination shows calcification around the coronary ostia, CABG may be necessary for the reconstruction of the coronary artery in modified Bentall's operation.