Neo Left Main Creation and Percutaneous Closure of Left Coronary Button Pseudoaneurysm After Bentall Procedure
Carlos E Vergara-Uzcategui1, Antonio Martinez de la Cuesta2, Gorka Bastarrika2
1Department of Cardiology, Clínica Universidad de Navarra, Pamplona, Spain.
Background:
Pseudoaneurysms are a rare but serious complication after aortic valve replacement and Bentall procedures, posing management challenges in high-risk patients.
Case Summary:
A 78-year-old woman with prior aortic valve replacement and Bentall surgery developed a pseudoaneurysm at the left coronary artery anastomosis, detected 4 years later during routine echocardiography. Computed tomography revealed a 35 × 29-mm saccular pseudoaneurysm at the left coronary artery button. A percutaneous approach was chosen, deploying a drug-eluting stent from the left main coronary artery ostium to the aortic graft, creating a supportive tunnel. A coronary stent graft was placed within this tunnel, forming a neo left main coronary artery. Endovascular coils successfully occluded the pseudoaneurysm without compromising coronary flow. Follow-up at 6 months confirmed exclusion and clinical stability.
Discussion:
This case highlights percutaneous intervention as a feasible, less invasive alternative to reoperation for post-Bentall surgery pseudoaneurysms in high-risk patients.
Take-Home Message:
Multidisciplinary planning is essential for optimizing outcomes in complex endovascular interventions.
