Kanemura Takeyuki, Nakahara Yoshinori, Tateishi Retsu, Haba Fumiya, Ono Shunya
Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan.
J Surg Case Rep. 2024 Feb 22;2024(2):rjae080. doi: 10.1093/jscr/rjae080. eCollection 2024 Feb.
Here, we present a case report detailing a pseudoaneurysm of the coronary button due to aortic remodeling that occurred 2 years after aortic root replacement. The patient was referred to our hospital with a diagnosis of left coronary artery pseudoaneurysm. Intraoperative findings revealed substantially loosened sutures in both the left and right coronary arteries with bleeding. Specifically, the left coronary artery was detached at the 6-9 o'clock positions. The operation was concluded with ligation of the loose suture and addition of a new suture. Chronic dissection thickened the aortic wall of the coronary artery ostium in the initial Bentall operation, whereas the sutured coronary button in this operation exhibited a normal arterial wall without a thickened dissected intima. This suggests that aortic wall remodelling of the coronary ostium leads to suture loosening and subsequent haemorrhage. Aortic wall remodeling may lead to bleeding or pseudoaneurysms during the remote period.
在此，我们报告一例病例，详细介绍了主动脉根部置换术后2年因主动脉重塑导致的冠状动脉纽扣状假性动脉瘤。该患者因左冠状动脉假性动脉瘤被转诊至我院。术中发现左、右冠状动脉的缝线均明显松动并有出血。具体而言，左冠状动脉在6至9点位置处分离。手术通过结扎松动的缝线并添加新缝线完成。在最初的Bentall手术中，慢性夹层使冠状动脉开口处的主动脉壁增厚，而此次手术中缝合的冠状动脉纽扣显示动脉壁正常，无增厚的夹层内膜。这表明冠状动脉开口处的主动脉壁重塑会导致缝线松动并随后出血。主动脉壁重塑可能在远期导致出血或假性动脉瘤。
