What is the clinical evidence from this study?

Study design: Case Report. Population: Prosthetic valve dehiscence and aortic root pseudoaneurysm (n=1). Intervention: Bentall procedure with graft insertion technique. Primary outcome: Left ventricular outflow tract (LVOT) narrowing.

What does this research mean for the field?

The graft insertion technique used in redo aortic root reconstruction can lead to postoperative left ventricular outflow tract (LVOT) narrowing and functional stenosis caused by the intraventricular portion of the inverted graft. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To highlight the impact of the graft insertion technique on postoperative LVOT geometry and flow dynamics after a Bentall procedure.

June 24, 2026General Thoracic and Cardiovascular Surgery Cases0 citationsOpen Access

Left ventricular outflow tract stenosis following Bentall procedure using the graft insertion technique: a case report

KYKoki YokawaKagawa Prefectural Central Hospital KYKazunori YoshidaKagawa Prefectural Central Hospital KIKo IshimotoKagawa Prefectural Central Hospital

Key Result

Redo aortic root replacement using the Bentall procedure with the graft insertion technique caused significant postoperative left ventricular outflow tract narrowing with a minimal diameter of 14 mm.

Key Points

To highlight the impact of the graft insertion technique on postoperative LVOT geometry and flow dynamics after a Bentall procedure.
Case presentation of a 69-year-old woman with aortic valve replacement and subsequent complications.
Redo aortic root replacement performed using the Bentall procedure with graft insertion technique.
Postoperative imaging assessed LVOT morphology and hemodynamics using contrast-enhanced CT and 4D-flow MRI.
Postoperative imaging showed significant LVOT narrowing with a minimal diameter of 14 mm after using a 19-mm bioprosthetic valve.
4D-flow MRI indicated accelerated systolic flow at the narrowed LVOT, demonstrating functional stenosis.
Findings suggest a risk of LVOT narrowing due to the intraventricular portion of the inverted graft.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Does the graft insertion technique in redo aortic root reconstruction cause postoperative LVOT narrowing?

Population

69-year-old woman with prosthetic valve dehiscence, paravalvular leakage, and large aortic root pseudoaneurysm 4 months after aortic valve replacement for infective endocarditis (n=1)

Intervention

Redo aortic root replacement using the Bentall procedure with the graft insertion technique

Outcome

Postoperative left ventricular outflow tract (LVOT) geometry and flow dynamicssurrogate

The graft insertion technique for redo aortic root reconstruction can cause postoperative LVOT narrowing, highlighting the utility of advanced imaging like 4D-flow MRI for postoperative evaluation.

Limitations

A ball sizer or Hegar dilator was not used during knot tying, which may have contributed to the development of LVOT stenosis.
Postoperative echocardiographic assessment could not adequately visualize the LVOT or reliably obtain Doppler-derived measurements.

Abstract

Abstract Background The graft insertion technique is an effective choice for redo aortic root reconstruction in cases with extensive annular destruction. Nevertheless, its impact on postoperative left ventricular outflow tract (LVOT) geometry and flow dynamics has not been investigated in detail. Case presentation A 69-year-old woman who underwent aortic valve replacement for infective endocarditis developed prosthetic valve dehiscence with paravalvular leakage and a large aortic root pseudoaneurysm after 4 months. Because the native annulus was completely destroyed, redo aortic root replacement using the Bentall procedure with the graft insertion technique was performed. Intraoperative examination revealed no macroscopic evidence of active infection but raised concerns regarding potential LVOT narrowing after the insertion of the inverted graft. Postoperative contrast-enhanced computed tomography demonstrated significant LVOT narrowing, with a minimal diameter of 14 mm, despite the implantation of a 19-mm bioprosthetic valve. Moreover, four-dimensional flow (4D-flow) magnetic resonance imaging (MRI) revealed accelerated systolic flow at the narrowed LVOT, indicating functional LVOT stenosis. Conclusions This case emphasizes an important pitfall of the graft insertion technique—postoperative LVOT narrowing caused by the intraventricular portion of the inverted graft. Postoperative morphological and hemodynamic evaluation using advanced imaging modalities, including 4D-flow MRI, may be required to ensure the safety of this technique in complex aortic root reconstruction.

问 AI

Bookmark

View Full Paper