Coronary pseudoaneurysm after Bentall-Bono intervention: A novel treatment to a rare surgery complication

Abstract

We present a rare case of a coronary pseudoaneurysm after a Bentall-Bono procedure. During a routine follow-up computed tomography scan, a pseudoaneurysm located between the aorta and the proximal portion of the right coronary artery was diagnosed. Contrast extravasation was observed with partial thrombosis of the pseudoaneurysm. Coronary angiography and intravascular ultrasound were performed showing the point of contrast extravasation dependent of the right coronary artery in its proximal portion. An angioplasty procedure was performed sealing the pseudoaneurysm with the implantation of a covered stent. After an uneventful postoperative follow-up, the patient was discharged home.

Learning objective: The development of a coronary artery pseudoaneurysm (CAP) after complex cardiac surgeries, like Bentall-Bono procedure, could be a life-threatening condition. The possible derived complications of CAP are rupture, compression of surrounding structures, or coronary ischemia.Although surgical approach to a CAP may have an extremely high surgical risk, most of the cases require a complex surgical repair. We describe a novel possible treatment option by angioplasty and sealing of the CAP with the implantation of a covered stent.

Keywords: Angioplasty; Bentall-Bono procedure; Cardiac surgery; Pseudoaneurysm.

Fig. 1

Angio computed tomography scan showing coronary artery pseudoaneurysm (red arrow) depending on right coronary artery. Axial cut (left) and 3D reconstruction (right).

Fig. 2

Coronary angiography showing a narrow neck coronary artery pseudoaneurysm (CAP) (red arrow) depending on the proximal segment of right coronary artery with contrast extravasation (a) and the posterior sealing of the CAP after the stent placement (b).

Fig. 3

Intravascular ultrasound showing the neck of the coronary artery pseudoaneurysm (red arrow).

Fig. 4

Control angio computed tomography scan: Axial cut (left) and 3D reconstruction (right) of the right coronary artery location showing the complete disappearance of the coronary artery pseudoaneurysm.