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Case Reports
. 2023 Jun 8;15(6):e40144.
doi: 10.7759/cureus.40144. eCollection 2023 Jun.

Right Coronary Artery Button Pseudoaneurysm After the Modified Bentall Procedure

Kaitlin A Nguyen  1 , Suresh Keshavamurthy  2 , Jeongae Yoon  3 , Mohammed A Kashem  1 , Yoshiya Toyoda  1
Affiliations
Case Reports

Right Coronary Artery Button Pseudoaneurysm After the Modified Bentall Procedure

Kaitlin A Nguyen et al. Cureus. .

Abstract

Anastomoses of the coronary buttons are the Achilles' heel of the modified Bentall procedure (MBP) for the repair of the aortic root and ascending aorta. We present a rare case of post-MBP right coronary artery button pseudoaneurysm in a 30-year-old man. The contained leak, attributed to a pseudoknot in the polypropylene suture, was visualized via computed tomography angiography and transesophageal echocardiogram and repaired under deep hypothermic circulatory arrest.

Keywords: bentall; coronary button pseudoaneurysm; coronary ostial complication; modified bentall procedure; pseudoaneurysm; pseudoknot.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Preoperative computed tomography angiography of the chest.
Large pericardial hematoma in retrosternal space (thin red arrow) with active extravasation (bold yellow arrow) from the right coronary artery re-implantation site: (A) axial view and (B) three-dimensional reconstruction.
Figure 2
Figure 2. Intraoperative transesophageal echocardiogram images.
Pseudoaneurysm with hematoma indicated by a thin red arrow. (A) Mid-esophageal aortic valve long-axis view: right coronary artery (RCA) button pseudoaneurysm anterior to the ascending aorta (Ao). (B) Upper esophageal ascending aortic short-axis view: pseudoaneurysm with compression of the right atrium (RA). (C) Color flow Doppler: two jets of blood flow (thick yellow arrows) visualized feeding pseudoaneurysm. (D) Color flow Doppler: post-repair of the RCA button and evacuation of the hematoma.
Figure 3
Figure 3. Illustration of the right coronary artery button before repair.
Polypropylene pseudoknot at the six o’clock position (red arrow), and areas of active extravasation at the two and eight o’clock positions (yellow stars).
See this image and copyright information in PMC

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