RESUMO
Though a high frequency of postoperative complications after an original Bentall procedure has been reported, several procedures that reduce the incidence of complications have been developed. Complications relating to anastomoses of the interposed graft are infrequent but life-threatening. This report describes a case of a 61-year-old man who presented with heart failure secondary to bilateral detachment of coronary ostial anastomoses and graft stenosis 21 years after undergoing a modified Bentall procedure. These complications were successfully repaired by reconstructing the conduit and coronary arteries.
Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte de Artéria Coronária , Vasos Coronários/cirurgia , Oclusão de Enxerto Vascular/cirurgia , Anastomose Cirúrgica , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Aneurisma da Aorta Torácica/diagnóstico , Aortografia/métodos , Angiografia Coronária/métodos , Oclusão de Enxerto Vascular/diagnóstico , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We describe a rare case of surgical repair of a coronary artery aneurysm with arteriosclerotic changes accompanied by coronary arteriovenous fistula (CAVF) after 26 years of conservative therapy. A 71-year-old woman, diagnosed with CAVF 26 years previously, was admitted to our hospital for general fatigue and dyspnea on exertion. Physical examinations revealed that the CAVF originated from the distal portion of the left circumflex artery (LCX), draining into the coronary sinus (CS); it affected the coronary artery aneurysm with arteriosclerotic changes and was calcified from the left coronary main trunk to the distal portion of the LCX. Treatment without resection of the calcified coronary aneurysm was suggested because of fear of excessive bleeding. The CAVF was closed directly from inside the dilated coronary sinus under cardiopulmonary bypass. The dilated ostium of the left coronary artery was closed using a Xenomedica patch. Coronary artery bypass grafting was performed in the left anterior descending artery (LAD) and posterolateral branch (PL) of the LCX using saphenous vein grafts. Postoperatively, the coronary aneurysm was spontaneously thrombosed for low blood flow. The bleeding might have been uncontrolled if the arteriosclerotic and calcified coronary aneurysm had been incised. Therefore, we successfully thrombosed the calcified coronary aneurysm without resection, after reducing the systemic blood flow to the coronary aneurysm and sustaining the coronary blood flow, performed with CABG.
