An Unusual Case: Bentall Procedure in a Patient with an Aberrant Coronary Artery and Three Coronary Ostia

Ayse Z. Karakoc, Adnan Ak, Melike Turkal, Ozgur Arslan, Mehmet Altug Tumcer

Kosuyolu Heart Training And Research Hospital , Istanbul, Turkey

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objectives: Coronary artery abnormalities are rare in general population than the other congenital cardiac anomalies. Although their incidence is not more than %5 among the patients undergoing coronary angiography and cardiac surgery per year; if there is a situation requires an open cardiac surgery for aortic aneurysm and root repair the surgical team need to consider this uncommon complexion to avoid from lethal complications.

Methods: A 55 year old male patient with aortic aneurysm which was sized 6.1 cm and placed in the ascendant aorta and severe aortic insufficiency in native aortic valve . The echocardiogram revealed that the ejection fraction was %30, there was severe insuffiency in aortic valve and the left atrium and left ventricle were dilated forwardly. After the arrangements; the patient underwent the bio-bentall procedure for the aneurysm repair. While the coronary buttons were resected isle shaped after the proximal graft anastomosis; the third aberrant coronary artery visualized 7-8 mm above the right coronary ostia then its button mobilized and resected as the same way by the surgeon either. Afterwards; the three coronary buttons were used for cardioplegia then the buttons were anastomosed above the bioprothesis valve conduit. Then the distal anastomosis was performed with the hemiarch replacement.

Results and conclusions: Although its rareness among all cases; the coronary artery anomalies must be consider especially when we are planning for an intervention to the aortic root reconstriction and aneurysm repair . In this case the patient weaned from cardiopulmonary bypass without any problem including massive bleeding and segmental wall motion abnormality. As the result the bio-bentall procedure for the aortic aneurysm can be perform safely by a professional surgical team ; for the patients which have unusual coronary artery abnormalities just like in this case.