Acute Non-Dominant Right Coronary Artery Occlusion After Bentall Surgery Presenting With Aslanger Pattern
Miguel López-Tejada1, Alberto Piserra-López1, Carlos Acosta-Sánchez2
1Heart Area-Cardiology Unit, Virgen de la Victoria University Hospital-IBIMA BIONAND Platform, Málaga, Spain.
Background:
Acute coronary occlusion is an uncommon but potentially catastrophic complication after a Bentall procedure. Atypical electrocardiographic presentations may delay recognition.
Case Summary:
A 55-year-old man underwent elective Bentall surgery for severe aortic regurgitation and ascending aortic aneurysm. After an initially uneventful postoperative course, he developed sudden cardiac arrest on postoperative day 3. After resuscitation, electrocardiography demonstrated an Aslanger pattern. Urgent coronary angiography revealed acute ostial occlusion of a nondominant right coronary artery, successfully treated with percutaneous coronary intervention, with subsequent clinical recovery.
Discussion:
Coronary obstruction after Bentall surgery, although rare, should be promptly considered in cases of unexpected postoperative instability. This case underscores the diagnostic value of high-risk electrocardiographic patterns beyond classic ST-segment elevation and highlights the clinical relevance of nondominant right coronary artery involvement.
Take-Home Messages:
Unexpected instability after Bentall surgery should prompt suspicion of coronary obstruction. Recognition of the Aslanger pattern may facilitate timely life-saving revascularization.
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