Dynamic kinking of right coronary artery after the button Bentall procedure

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Tomoki Fukui1, Nobuyuki Ogasawara2, Shinji Hasegawa2

  • 1Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan tomoki.fukui@gmail.com.

BMJ Case Reports
|January 29, 2021
PubMed

Insights

Postoperative complications affecting the right coronary artery (RCA) after button Bentall procedures are rare but serious. This case highlights successful percutaneous coronary intervention (PCI) for RCA kinking, improving patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Radiology

Background:

  • Bentall procedures, particularly the button Bentall technique, are used for aortic root and ascending aorta aneurysms.
  • Postoperative complications involving the coronary arteries, though rare, can be life-threatening.

Observation:

  • A 72-year-old male developed silent myocardial ischemia following a button Bentall procedure.
  • Incidental detection of a right coronary artery (RCA) complication via multidetector CT on postoperative day 15.
  • Coronary angiography revealed proximal RCA kinking, involving the native artery rather than an anastomosis.

Findings:

  • The patient underwent successful percutaneous coronary intervention (PCI) with drug-eluting stent implantation for the RCA kinking.
  • A review of this case and five prior instances reveals a pattern of RCA complications post-button Bentall procedure treated with PCI.

Implications:

  • Increased awareness of potential right coronary artery complications after button Bentall procedures is crucial.
  • Percutaneous coronary intervention (PCI) is an effective treatment modality for these rare but serious complications.
  • Early detection through imaging like CT angiography aids in timely intervention and management.

Keywords:
cardiothoracic surgeryinterventional cardiologyischaemic heart disease

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