[Successful surgical repair of composite graft detachment occurred 5 months after combined Bentall's operation and graft replacement with active aortitis syndrome].

Ninteen-year-old male with annuloaortic ectasia and resultant massive aortic valvular regurgitation, along with aortic aneurysmal dilatation extending from the root to the distal arch, underwent surgical repair at our hospital. Operative procedure comprised composite graft replacement of aortic valve-ascending aorta (Bentall's operation with Piehler's modification), combined with the aortic arch replacement with reconstruction of the neck vessels. Physical, laboratory, and histopathological findings revealed active aortitis syndrome as the etiology of this aortic disease. Five months after operation, this patient was readmitted because of his anemia and complaint of dyspnea. Two days after admission, his condition rapidly deteriorated into pulmonary edema with fall of blood pressure to 70 mmHg. Fluoroscopic examination taken after emergency intubation and mechanical ventilatory support showed malfunction of the aortic valve prosthesis. Circulatory assist was accomplished with intraaortic balloon counterpulsation and percutaneous cardiopulmonary bypass support, and emergent operation was carried out. On reentry into the anterior mediastinum, expansion of the aortic wall wrapping the graft was found. Incision into the wrapped aortic wall revealed dehiscence of the composite graft from the aortic annulus at the sites of right coronary cusp and noncoronary cusp position. Pooled blood between the graft and the wrapped aortic wall compressed the composite graft, resulting in tilting of the bi-leaflet mechanical valve prosthesis and restraint of the motion of one occluder. Retachment of the composite graft to the annulus from outside of the wrapped aortic root wall by seven felt-buttressed mattress sutures of 3-0 polypropylene was performed. Postoperative course was smooth and successive strict antiinflammatory therapy with corticosteroid has successfully controlled the aortitis and the patient has been well after a follow-up of 18 months.