Upward Displacement of Prosthetic Aortic Valved Conduit after Modified Bentall Procedure for Type A Acute Aortic Dissection.

Aim: Role of non-invasive coronary artery computed tomography (CACT) in diagnosis of complications of aortic root surgery in patients with chest pain. Introduction: Dehiscence of an aortic valved conduit or pseudoaneurysm development is a rare, but serious and potentially life-threatening complication after aortic root surgery. Case Presentation: We report an interesting case of a 61-year-old man with chest pain and dyspnea, previous history of modified Bentall procedure for type A acute aortic dissection and coronary stenting, that shows a complete detachment and upward displacement of a composite tubular graft with mechanical valve prosthesis detected by a CACT angiography. Discussion: Generally, in the few survivors, the diagnosis is made by means of echocardiography. This is the first case of CACT diagnosis of a prosthetic aortic valved conduit displacement after amodified Bentall procedure for type A acute aortic dissection. With the use of this imaging technique was possible a complete evaluation of the coronary stents and the native coronary arteries, avoiding the coronary artery angiography that adds an elevation of the risk for this kind of patients. Conclusion: In symptomatic patients with a previous history of treated aortic dissection and coronary artery disease without evidence of recurrent ischemia, the CACT angiography can be considered a good diagnostic option. It provides detailed informations about the coronary arteries and the aorta allowing an accurate diagnosis.

Use of Aortic Valved Grafts for Apico-aortic Conduit Bypass / 日本心臓血管外科学会雑誌

We describe the case of a 60-year-old woman with severe aortic stenosis and severe calcification of the thoracic aorta, who underwent an apico-aortic conduit bypass using an aortic valved graft. Because of stenosis of the annulus of the aortic valve and severe calcification of the thoracic aorta (porcelain aorta), we did not perform ordinary aortic valve replacement. Instead, apico-aortic conduit bypass surgery was performed using a St. Jude Medical Aortic Valved Graft (19-20 mm : St. Jude Medical, St. Paul, MN, USA) and cardiopulmonary bypass (CPB) surgery was performed using descending aortic perfusion and left pulmonary artery drainage, while the subject was in the right decubitus position. The descending aorta was clamped and a 20-mm graft (Hemashield Platinum ; Boston Scientific/Medi-tech, Natick, MA, USA) was sutured to it. Under ventricular fibrillation, the left ventricular apex was circularly resected using a puncher with a diameter identical to that of the 20-mm graft, in order to create a new outflow for the conduit bypass. The graft was sutured to the outflow, and a torus-shaped equine pericardial sheet was used to reinforce the suture line. After recovery of the heartbeat, the aortic valved graft was first sutured to the graft at the outflow and then to the graft at the descending aorta. The CPB time was 285 min and ventricular fibrillation time was 36 min. Therefore, the benefits of using an aortic valved conduit for apico-aortic conduit bypass are reduced operation time, since there is no need to prepare a handmade valve conduit, and easy management of the grafts which are made of the same material.