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Table of Contents
LETTERS TO EDITOR  
Year : 2023  |  Volume : 26  |  Issue : 1  |  Page : 113-114
Cardiogenic shock secondary to ostial compromise of left main immediately after bentall surgical intervention and aortic valve replacement


1 Department of Interventional Cardiology, IdiPAZ, University Hospital La Paz, Madrid, Spain
2 Department of Cardiac Surgery, IdiPAZ, University Hospital La Paz, Madrid, Spain
3 Department of Cardiothoracic Anaesthesia, IdiPAZ, University Hospital La Paz, Madrid, Spain

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Date of Submission17-Feb-2021
Date of Acceptance13-Jun-2021
Date of Web Publication03-Jan-2023
 

How to cite this article:
Cobarro L, García-Escobar A, Ramírez U, Moreno-Gómez I, Jurado-Román A, Galeote G, Jimenez-Valero S, Poveda D, Moreno R. Cardiogenic shock secondary to ostial compromise of left main immediately after bentall surgical intervention and aortic valve replacement. Ann Card Anaesth 2023;26:113-4

How to cite this URL:
Cobarro L, García-Escobar A, Ramírez U, Moreno-Gómez I, Jurado-Román A, Galeote G, Jimenez-Valero S, Poveda D, Moreno R. Cardiogenic shock secondary to ostial compromise of left main immediately after bentall surgical intervention and aortic valve replacement. Ann Card Anaesth [serial online] 2023 [cited 2023 Jan 30];26:113-4. Available from: https://www.annals.in/text.asp?2023/26/1/113/367012




To the Editor

Severe complications may occur both after surgical and percutaneous aortic valve interventions.[1],[2] During Bentall surgery, a Dacron graft (that may include a prosthetic valve) replaces the ascending aorta, and coronary ostia are sewn into the graft. Iatrogenic coronary ostial stenosis after aortic valve replacement and Bentall procedure is a rare but life-threatening complication. We describe a patient who immediately after a Bentall procedure suffered cardiogenic shock secondary to the left main compromise.

The patient was a 63-year-old male, with chronic coronary artery disease (previous inferior infarction, and stenting to the left anterior descending) and previous methallic aortic valve replacement for aortic regurgitation 4 years before. Currently, a Bentall surgical intervention (26 mm graft and 23 mm methallic prosthetic aortic valve) was performed to treat a 59 cm × 54 cm Valsalva sinus aneurysm. Immediately after surgery, he presented repetitive episodes of ventricular fibrillation and cardiogenic shock. After an intra-aortic balloon pump insertion, he was referred for coronary angiography. Severe stenosis of the left main was observed attributed to external compression by the surgical glue. A balloon predilatation and coronary stent implantation were performed [Figure 1]. The clinical outcome was favorable, with hemodynamic stabilization and no further episodes of arrhythmia. The left ventricular ejection fraction 4 days later was 52%, and the patient was discharged 6 days after the intervention.
Figure 1: Coronary angiography (a) First angiographic image showing severe stenosis at the left main. (b) Predilatation with a 3.0 mm × 13 mm balloon (c) Result after balloon predilatation (d) Implantation of a BioFreedom 3.5 mm × 14 mm (Biosensors) coronary stent (e) Postdilatation with a non-compliant 4.5 mm × 8 mm balloon. (f) Final result

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Iatrogenic coronary ostial stenosis after Bentall is an infrequent complication that may be the result of an imperfect suture technique[3] or an external compression from the surgical glue.[4] It should be suspected in the presence of hemodynamic impairment after a surgical intervention or signs of myocardial ischemia even months after the operation—[5] coronary stenting being the treatment of choice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Panchal HB, Ladia V, Desai S, Shah T, Ramu V. A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events following transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis. Am J Cardiol 2013;112:850-60.  Back to cited text no. 1
    
2.
Moreno R, Calvo L, Salinas P, Dobarro D, Santiago JV, Sanchez-Recalde A, et al. Causes of peri-operative mortality after transcatheter aortic valve implantation: A pooled analysis of 12 studies and 1223 patients. J Invasive Cardiol 2011;23:180-4.  Back to cited text no. 2
    
3.
Balbi M, Olivotti L, Scarano F, Bertero G, Passerone G, Brunelli C, et al. Percutaneous treatment of left main coronary stenosis as a late complication of Bentall operation for acute aortic dissection. Catheter Cardiovasc Interv 2004;62:343-5.  Back to cited text no. 3
    
4.
Marino M, Cellini C, Tsiopoulos V, Pavone N, Zamparelli R, Corrado M, et al. A case of myocardial infarction effectively treated by emergency coronary stenting soon after a Bentall-De Bono aortic surgery. Cardiovasc Revasc Med 2010;11:263.e5-9.  Back to cited text no. 4
    
5.
Haji-Zeinali AM, Bozorgi A, Ahmadi SH, Shahrzad M. Percutaneous treatment of left main coronary stenosis following Bentall surgery. J Card Surg 2014;29:628-9.  Back to cited text no. 5
    

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Correspondence Address:
Raúl Moreno
Director of Interventional Cardiology, University Hospital La Paz, Paseo La Castellana, 261, 28045 Madrid
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_21_21

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