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[A case of progressive right coronary ostial stenosis after Carrel patch method using gelatin-resorcin-formalin glue]
H Kiyama1, N Ohshima, M Sakurada
1Department of Cardiovascular Surgery, Sekishinkai Sayama Hospital, Saitama, Japan.
Insights
This study details a type A chronic aortic dissection repair using graft replacement and Carrel patch coronary reconstruction. Post-surgery, the patient experienced significant right coronary artery ostial stenosis, possibly linked to GRF glue injection.
Area of Science:
- Cardiovascular Surgery
- Aortic Disease
- Interventional Cardiology
Background:
- Type A chronic aortic dissection with annuloaortic ectasia presents complex surgical challenges.
- Concomitant aortic root and transverse aortic arch replacement is a viable treatment option.
- Coronary artery reconstruction is crucial in aortic dissection repair.
Observation:
- A 31-year-old male patient underwent total aortic root and transverse aortic arch graft replacement.
- Coronary arteries were reconstructed using the Carrel patch method.
- The right coronary artery false lumen was sealed with GRF glue.
Findings:
- Postoperative recovery was uneventful, with the patient returning to normal activities within 2 months.
- Coronary angiography at 6 months revealed remarkable progression of right coronary artery ostial stenosis.
- The exact cause of progressive stenosis remains unclear, but GRF glue injection is a potential factor.
Implications:
- GRF glue injection for coronary artery false lumen closure may be associated with delayed ostial stenosis.
- Further research is needed to elucidate the etiology of progressive stenosis after aortic dissection repair.
- This case highlights the importance of long-term surveillance for coronary artery complications post-aortic surgery.
Abstract:
A 31-year-old man with type A chronic aortic dissection associated with annuloaortic ectasia underwent the concomitant graft replacement of the total aortic root and the transverse aortic arch. The two coronary arteries were reconstructed using the Carrel patch method. The false lumen of right coronary artery was closed by injection of GRF glue into the dissected space and compressing the dissected layers. Postoperative course was uneventful, and the patient has returned to normal daily life 2 months after surgery. Remarkable progression of the right coronary artery ostial stenosis was observed by coronary angiography 6 months after surgery. The remarkable progression of stenosis may occur in association with injection of GRF glue into the dissected space, although the exact etiology of the progressive stenosis remains obscure.