Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

True Aneurysm of the Common Coronary Button in a Marfan Patient with an Anomalous Right Coronary Artery after a Bentall Procedure: A Case Report

  • Jo, Jeong Jun (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Kim, Yun Seok (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Kim, Gun-Jik (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Kim, Jae Hyun (Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine)
  • Received : 2022.02.03
  • Accepted : 2022.04.10
  • Published : 2022.06.05
Download PDF
⟨ Previous Next ⟩

Abstract

True aneurysms of the coronary artery after aortic root replacement in Marfan syndrome patients are very rare. An anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva adds complexity during aortic root surgery. We present a case of a 37-year-old male patient with Marfan syndrome who had an RCA anomaly and a 4.5-cm true aneurysm of the common coronary button 14 years after a previous Bentall procedure. A redo Bentall operation and hemi-arch replacement were successfully performed. The anomalous origin of the RCA from the left sinus of Valsalva was safely divided and anastomosed as separate coronary buttons to the prosthetic composite valve graft. To prevent coronary button aneurysms after aortic root surgery in Marfan patients, the coronary buttons and the corresponding side holes on the prosthetic graft must be reduced to the maximum possible extent.

Keywords

References

  1. Savunen T, Inberg M, Niinikoski J, Rantakokko V, Vanttinen E. Composite graft in annulo-aortic ectasia: nineteen years' experience without graft inclusion. Eur J Cardiothorac Surg 1996;10:428-32. https://doi.org/10.1016/S1010-7940(96)80110-2
  2. Meijboom LJ, Nollen GJ, Merchant N, et al. Frequency of coronary ostial aneurysms after aortic root surgery in patients with the Marfan syndrome. Am J Cardiol 2002;89:1135-8. https://doi.org/10.1016/S0002-9149(02)02290-7
  3. Haroun RR, Chu LC, Fishman EK. Prevalence and natural history of coronary ostial aneurysms in Marfan patients. J Comput Assist Tomogr 2019;43:115-8. https://doi.org/10.1097/RCT.0000000000000799
  4. Onoda K, Tanaka K, Yuasa U, Shimono T, Shimpo H, Yada I. Coronary artery aneurysm in a patient with Marfan syndrome. Ann Thorac Surg 2001;72:1374-7. https://doi.org/10.1016/S0003-4975(00)02707-7
  5. Kazui T, Yamashita K, Terada H, et al. Late reoperation for proximal aortic and arch complications after previous composite graft replacement in Marfan patients. Ann Thorac Surg 2003;76:1203-8. https://doi.org/10.1016/S0003-4975(03)00719-7
  6. Okamoto K, Casselman FP, De Geest R, Vanermen H. Giant left coronary ostial aneurysm after modified Bentall procedure in a Marfan patient. Interact Cardiovasc Thorac Surg 2008;7:1164-6. https://doi.org/10.1510/icvts.2008.183103
  7. Bruschi G, Cannata A, Botta L, Martinelli L. Giant true aneurysm of the right coronary artery button long after aortic root replacement. Eur J Cardiothorac Surg 2013;43:e139-40. https://doi.org/10.1093/ejcts/ezt057
  8. Chalkley RA, Roberts WC, Patlolla S, et al. Giant right coronary artery aneurysms. Am J Cardiol 2020;125:1599-601. https://doi.org/10.1016/j.amjcard.2020.02.008