Asian Cardiovasc Thorac Ann 2004;12:182-183
© 2004 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Pseudoaneurysm in a Marfan Patient 16 Years after Bentall Operation
Martin TR Grapow, MD,
Peter Matt, MD,
Hans-Reinhard Zerkowski, MD,
Franziska Bernet, MD
Division of Cardio-Thoracic Surgery, University of Basel, Switzerland
For reprint information contact: Martin TR Grapow, MD Tel: 41 61 265 2525 Fax: 1 530 831 4920 Email: mgrapow{at}uhbs.ch Division of Cardio-Thoracic Surgery, Kantonsspital Basel, University of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland.
A 60-year old male patient was admitted to our hospital with acute inferior myocardial infarction. The history of the patient revealed a replacement of the ascending aorta and the aortic valve with a composite graft (Bentall operation). This was due to Marfan syndrome with giant aneurysm of the ascending aorta combined with aortic valve insufficiency. Angiography (Figure 1
) and computed tomography (CT) scan (Figure 2) showed a giant pseudoaneurysm around the composite graft. The coronarography revealed a total occlusion of the right proximal coronary artery and a normal left coronary artery system. At surgery, after incision of the pseudoaneurysm, a huge, open-wide orifice of the right coronary ostium in the Bentall-graft was unexpectedly found (Figure 3). The suture-line seemed to be torn out of the coronary ostium, indicating a generalized instability of the arterial wall due to the typical molecular defects in Marfan syndrome. After control and stabilization of the left ostium with a new suture repaired from inside the composite-graft, a saphenous vein graft to the right coronary artery was implanted into the right ostium. The postoperative course was uneventful and the patient was discharged nine days after surgery.
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Figure 1. Angiogram of the ascending aorta. The white points border the stroke of contrast medium floating into the pseudoaneurysm, the arrow points at the left main coronary artery, and the white circle on the right side gives an estimation of the pseudoaneurysm size.
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Figure 2. The CT scan shows the giant pseudoaneurysm with the contrast medium white coloured composite graft inside.
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Figure 3. View from cranial through the longitudinally dissected membrane of the pseudoaneurysm. It shows the composite graft with the open wide coronary ostium and the torn out blue suture line.
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P. Matt and F. Eckstein
eComment: Stabilizing aortic tissue after aortic root surgery in Marfan syndrome
Interactive CardioVascular and Thoracic Surgery,
December 1, 2008;
7(6):
1166 - 1166.
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