[Reoperation for late pseudoaneurysm in the ascending aorta following the modified Bentall procedure--a case report]

We performed reoperation for annuloaortic ectasia (AAE) in a patient with Marfan's syndrome. The initial operation was the modified Bentall procedure, in which the root of the ascending aorta and the aortic valve were replaced with a composite graft with a prosthetic mechanical valve, and the coronary arteries were reconstructed by direct anastomosis to the right coronary ostium or with an interposing graft to the left coronary ostium. At 1 year and 6 months after the initial operation, a pseudoaneurysm developed in the ascending aorta following the reconstructed coronary ostium on the right side was detached. At reoperation, the hole in the composite graft was closed, but the right coronary artery could not be reconstructed. Her postoperative course was uneventful. In addition, Piehler's method is effective for reconstruction of the coronary arteries, especially for patients with AAE in the Marfan's syndrome.