Key result
Surgical exclusion of giant RCA aneurysm succeeds despite refractory VF requiring emergent resternotomy.
Why the study?
Refractory recurrent ventricular fibrillation after cardiopulmonary bypass in aortic root replacement is uncommon and its causes require clarification.
Case Report (n=1)
Coronary insufficiency should be considered as a potential cause of refractory ventricular fibrillation after aortic root replacement, which can be effectively treated with CABG.
BACKGROUND: In open heart surgery requiring cardiopulmonary bypass (CPB), ventricular fibrillation (VF) is common, but refractory recurrent VF is uncommon but perilous. CASE SUMMARY: This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB. The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root. Coronary artery bypass grafting (CABG) of the proximal right coronary artery and the left anterior descending artery successfully resolved VF. Finally, this patient was safely transferred to the postoperative intensive care unit, and was discharged successfully after subsequent supportive treatment. CONCLUSION: In aortic root replacement, coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis. CABG is the sole effective treatment for VF caused by coronary insufficiency.
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Zhu et al. (2025) conducted a case report in Giant right coronary artery aneurysm with fistulous communication to the right atrium (n=1). Surgical repair (aneurysm ligation and saphenous vein graft to PDA) was evaluated on Clinical recovery. Surgical exclusion of a giant right coronary artery aneurysm with a saphenous vein graft was successfully performed, though complicated by refractory ventricular fibrillation requiring emergent resternotomy.
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