Aortic root bentall graft disarticulation following repair of type a aortic dissection

A 47-year-old man presented with chest pain and was found to have an ascending aortic dissection. He underwent aortic arch resection and replacement with a hemishield tube graft with a valve conduit, better known as the Bentall technique. Five months later he presented with shortness of breath. A transesophageal echocardiogram revealed near-complete dehiscence of the mechanical valve conduit and a periaortic root abscess. He underwent removal of the conduit and placement of a homograft aortic root and valve. One month later he developed rigors. A transthoracic echocardiogram showed worsening systolic function and a periaortic hematoma or abscess. Serial transthoracic echocardiograms revealed increasing size in the periaortic echogenic free space and subsequent evidence of flow from the left ventricle into the periaortic space. He was determined not to be a surgical candidate and discharged to hospice in fair condition. He subsequently expired.