Why the study?
Sufficient statistical evidence was lacking to guide surgical intervention for recurrent ascending aortic stenosis with bilateral coronary aneurysms and substantial left ventricular hypertrophy without causing coronary flow mismatch.
Computerized virtual surgery using computational fluid dynamics can effectively guide complex surgical planning in adult congenital heart disease.
May require cautious reoperation planning to avert coronary mismatch; leaves optimal strategy open in this rare re-stenosis scenario.
A 38-year-old woman presented with exertional dyspnea and chest compression. She had undergone repair of congenital supravalvular aortic stenosis at 8 years of age. Contrast-enhanced computed tomography showed re-stenosis in the ascending aorta, bilateral coronary arterial aneurysm, and a highly thickened left ventricular wall. Release of stenosis was necessary to avoid left ventricular functional deterioration; however, it could cause demand-supply mismatch in coronary flow due to substantial left ventricular hypertrophy. Sufficient statistical evidence was not available in this situation; therefore, computerized virtual surgery based on computational fluid dynamics (CFD) was performed to predict the postoperative hemodynamics. Consequently, root replacement with in situ Carrel patch coronary reconstruction was considered a better option than coronary artery graft bypass in the left-side coronary flow supply. The patient underwent root replacement with in situ Carrel patch coronary reconstruction as planned based on CFD without any complication and was discharged 15 days postoperatively.
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Hohri et al. (2020) studied this question.
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