Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran, Kermanshah, Iran.
Folia Med (Plovdiv). 2021 Dec 31;63(6):981-984. doi: 10.3897/folmed.63.e57294.
Bentall operation is considered a gold standard of surgery in the treatment of ascending aortic aneurysm. This operation with en-bloc resection of ascending aorta and aortic valve requires aortic valve with two coronary bottoms re-replacements in a prepared composite graft. The four important locations for the pseudoaneurysm include proximal and distal composite graft anastomosis and two coronary bottom sites. However, many complications have been reported with this technique but the most serious complication associated with this operation is defined as pseudoaneurysm. We report an exceedingly rare case of subaortic ring pseudoaneurysm in retro composite graft position enclosed by infected surgical that was used to control bleeding in this location. Dehiscence occurred between the aortic ring and the underlying left ventricular muscle. The aortic ring was separated from the underlying muscle by the high tensile strength of sewing ring sutures. The pseudoaneurysm compressing the left atrium without communicating with any cardiac chamber and presenting with high fever (39°C), chills, a few months after Bentall operation. The patient underwent redo operation and repair of the dehiscence's site. The 6-month follow-up revealed no recurrence of a pseudoaneurysm. The uniqueness of this case report is related to the site of pseudoaneurysm between the aortic ring and underlying left ventricular muscle that have not been reported in the medical literature so far.
Bentall 手术被认为是治疗升主动脉瘤的金标准手术。该手术需要整块切除升主动脉和主动脉瓣，并在准备好的复合移植物中重新替换带有两个冠状动脉底部的主动脉瓣。假性动脉瘤的四个重要部位包括近端和远端复合移植物吻合口以及两个冠状动脉底部部位。然而，该技术已经报道了许多并发症，但与该手术相关的最严重并发症被定义为假性动脉瘤。我们报告了一个极为罕见的病例，即感染性外科手术包裹的主动脉瓣下环形假性动脉瘤位于逆行复合移植物位置。主动脉环和下方左心室肌肉之间发生了崩开。主动脉环被缝合环缝线的高强度从下方的肌肉中分离出来。假性动脉瘤压迫左心房，但与任何心腔均无连通，术后数月出现高热（39°C）、寒战。患者接受了再次手术，并修复了崩开的部位。6 个月的随访显示无假性动脉瘤复发。本病例报告的独特之处在于假性动脉瘤位于主动脉环和下方左心室肌肉之间，这在医学文献中尚未报道过。
