Repairing left ventricular outflow after aortic composite graft pseudoaneurysm: case report

• DOI: 10.1186/s43044-022-00307-4
• Publication Date: 2022-11-08T09:03:22Z
• Authors: Rita Caldeira da ...; Kisa Congo; Manuel Trinca; Álvaro Laranjeira...
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Left ventricular outflow reconstruction; RC666-701; Diseases of the circulatory (Cardiovascular) system; Case Report; Bentall redo procedure; Rheumatoid arthritis; Composite graft dehiscence; 3. Good health

Abstract Background We present a technique for aortic composite graft implantation after left ventricular outflow tract destruction due to its proximal dehiscence.

Case presentation A 53-year-old gentleman with rheumatoid arthritis and history of Bentall procedure, presented with heart failure symptoms for the past month. Transthoracic echocardiogram identified prosthetic valve dysfunction, and transesophageal echocardiogram detected that its mechanism was by dehiscence. After excluding infectious etiology, it was hypothesized that the cause was the absence of endothelialization, owing to immunosuppressive therapy. Repair surgery was successful, and 2 years later, the patient is fully asymptomatic.

Conclusions Immunosuppressive drugs are a rare cause of aortic composite graft dehiscence. Left ventricular outflow tract surgical reconstruction remains an extremely complex and high-risk intervention, with the need for reentry into cardiopulmonary bypass and graft proximal segment implantation in a lower position.