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[A case report of sudden death after Bentall's operation (Piehler's modification) due to left coronary occlusion]
1Department Cardiovascular Surgery, Hoshi General Hospital, Koriyama, Japan.
Insights
A rare complication of left coronary artery occlusion occurred after Bentall
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Bentall's operation (Piehler's modification) is a complex procedure for aortic reconstruction.
- Chronic dissecting aortic aneurysm (DeBakey type I) requires surgical intervention.
- The case involved a 56-year-old male with a 7 cm aortic aneurysm.
Observation:
- A rare complication of left coronary artery occlusion was observed post-Bentall's operation.
- The patient experienced anterior chest pain and ventricular fibrillation on postoperative day 22.
- Emergent angiography confirmed total occlusion of the left coronary artery.
Findings:
- Percutaneous transluminal coronary angioplasty provided only temporary success.
- Autopsy revealed no thrombus or kinking in the grafts.
- Elevated activated partial thromboplastin time (APTT) from 120 to 160 seconds was noted during respirator support.
Implications:
- This case highlights a rare but serious complication following Bentall's operation.
- Consideration for enhanced anticoagulation strategies during respirator-assisted periods is suggested.
- Further research into managing coronary complications after aortic reconstruction is warranted.
Abstract:
We encountered a rare complication after Bentall's operation (Piehler's modification) with the left coronary artery occlusion. A 56-year-old man admitted to our hospital to get the aortic reconstruction operation for the chronic dissecting aortic aneurysm (DeBakey type I) with 7 cm in diameter. We performed Piehler's modification procedure using a 26 mm and 8 mm woven Dacron tubes coated with gelatin, and 23 mm prosthetic valve (St. Jude Medical). He got well after 6-day intubation until he complained anterior chest pain suddenly on 22 postoperative day. He showed ventricular fibrillation on the second attack requiring resuscitation procedures. Emergent angiogram showed total occlusion of the left coronary artery. The percutaneous transluminal coronary angioplasty was performed only with temporal success. Autopsy revealed no thrombus in the grafts and no kinking of the tubes. We might have to use more anticoagulants during the respirator assisted period when the APTT was naturally prolonged from 120 to 160 seconds.