A Case of Pseudoaneurysm Following Coronary Anastomotic Dehiscence After the Bentall Procedure

In the original Bentall procedure using the inclusion technique, the incidence of pseudoaneurysm formation due to dehiscence at the anastomotic site of the composite graft ranges from 6.7% to 16.7%.In contrast, reoperation for anastomotic pseudoaneurysms is rarely observed with modifi ed Bentall procedures that employ alternative coronary artery reconstruction techniques [1][2][3] . Tis report describes a rare case of a pseudoaneurysm following the Bentall procedure, in which complete dehiscence of left coronary artery (LCA) anastomosis was incidentally detected without any symptoms or hemodynamic collapse, highlighting our surgical strategy and modifi cations that enabled the safe and successful completion of the procedure. Case reportA 58-year-old male patient had undergone aortic root replacement 6 years prior for annuloaortic ectasia.Chest radiography 1 month earlier revealed a prominent aortic arch.One week prior, contrast-enhanced computed tomography (CT) incidentally detected a significantly enlarged pseudoaneurysm close to the posterior aspect of the sternum.The distance between the sternum and the pseudoaneurysm measured approximately 4-6 mm (Fig. 1A,B), prompting an outpatient consultation.The patient was asymptomatic, had stable vital signs, and was admitted for elective surgical intervention during preoperative evaluation.His medical history included left-sided pneumothorax 40 years prior, for which a chest drain was placed, followed by adhesion therapy.Histopathological examination of the aortic wall from the initial surgery revealed findings indicative of connective tissue disorder.The blood test results revealed no significant abnormalities.Electrocardiography (ECG) showed a normal sinus rhythm without ST-segment changes or findings suggestive of ischemic heart disease.Transthoracic echocardiography demonstrated a left ventricular ejection fraction of 69.6%, without apparent wall motion abnormalities or valvular disease.