Key result
A re-Bentall procedure with direct coronary reconstruction successfully treated bilateral coronary ostial aneurysms and an aortic root pseudoaneurysm 15 years after the initial surgery.
Case Report (n=1)
No
Highlights the risk of late complications such as coronary ostial aneurysms and pseudoaneurysms after modified Bentall procedures in patients with connective tissue disorders, necessitating long-term follow-up.
Suggests lifelong surveillance after Bentall in Marfan syndrome; leaves open optimal strategies for late ostial aneurysms.
症例は62歳，男性，Marfan症候群．15年前に大動脈弁輪拡張症，大動脈弁閉鎖不全症，胸部大動脈瘤の診断で他院にてModified Bentall手術，上行弓部大動脈全置換術を施行した．その後外来で経過観察中に，CT検査にて左右冠動脈瘤とcomposite graft弁輪縫着部位に仮性動脈瘤を認め，手術目的で当院紹介となる．左右の冠動脈瘤壁は菲薄化し，基部に仮性瘤を認めた．人工弁を摘出し再大動脈基部置換術を施行，冠動脈は瘤を切除し直接再建した．Bentall原法では吻合部仮性動脈瘤の発生が問題であったが，Bentall変法となり手術成績は向上している．しかし，結合織異常を有する症例では術後合併症のリスクが高く，長期にわたる経過観察が必要である．
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Komatsu et al. (2020) conducted a case report in Bilateral coronary ostial aneurysms and aortic root pseudoaneurysm (n=1). Re-Bentall procedure was evaluated on Surgical success. A re-Bentall procedure with direct coronary reconstruction successfully treated bilateral coronary ostial aneurysms and an aortic root pseudoaneurysm 15 years after the initial surgery.
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