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Ostial stenosis after Bentall technique using glue: percutaneous stenting may be ineffective

Marcelo Trivi^*, Jorge Albertal, Guillermo Vaccarino, Mariano Albertal and Daniel Navia

Cardiovascular Institute of Buenos Aires, Blanco Encalada 1543, (1428) Buenos Aires, Argentina

*Corresponding author. Tel./fax: +54-11-4787-7500.

E-mail address: mstrivi{at}icba-cardiovascular.com.ar; marcelotrivi{at}yahoo.com (M. Trivi).

Background: Hemorrahage after coronary re-implantation during a Bentall surgery is a rare complication. In case of friable tissue, the use of a felt disc usually solves the problem. The use of resorcinol-formol-glue should be avoided to prevent tissue damage. Extrinsic compression of the coronary arteries has been reported with the use of this surgical glue. Case: We report a rare case of extrinsic compression of both coronary arteries after a Bentall procedure. A 50-year-old man with severe aortic valve stenosis, without coronary disease and an ascending aortic aneurysm, underwent a modified Bentall procedure with insertion of a valved tube and coronary re-implantation using surgical glue. Seven weeks later he suffered severe acute coronary ischemia and both coronary ostium were compressed by a dense and hard fibrose material. Three months after stenting, the patient required coronary surgery because of severe myocardial ischemia. Transesophageal and intracoronary ultrasounds were useful for the diagnosis of this rare complication. Conclusions: Use of glue should be avoided for coronary reimplantation during Bentall surgery. In cases of external ostial compression by glue reaction, stenting may be ineffective and surgical coronary revascularization may be needed.

Key Words: Bentall procedure; Aneurysm; Aorta; Coronary angiography; Angioplasty; Transesophageal echocardiography

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