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| Year : 2023
| Volume
: 26 | Issue : 1 | Page
: 113-114 |
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| Cardiogenic shock secondary to ostial compromise of left main immediately after bentall surgical intervention and aortic valve replacement |
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Lucía Cobarro1, Artemio García-Escobar1, Ulises Ramírez2, Isidro Moreno-Gómez3, Alfonso Jurado-Román1, Guillermo Galeote1, Santiago Jimenez-Valero1, Dolores Poveda1, Raúl Moreno1
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 Submission | 17-Feb-2021 |
| Date of Acceptance | 13-Jun-2021 |
| Date of Web Publication | 03-Jan-2023 |
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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 | |  |
| 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.  |
| 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. |
| 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. |
| 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. |
| 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. |
Correspondence Address:
Raúl Moreno
Director of Interventional Cardiology, University Hospital La Paz, Paseo La Castellana, 261, 28045 Madrid
Spain
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/aca.aca_21_21
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