Ostial stenosis after Bentall technique using glue: percutaneous stenting may be ineffective.
BACKGROUND
Hemorrahage after coronary re-implantation during a Bentall surgery is a rare complication. In case of friable tissue, the use of a felt disc usually solves the problem. The use of resorcinol-formol-glue should be avoided to prevent tissue damage. Extrinsic compression of the coronary arteries has been reported with the use of this surgical glue.


METHODS
We report a rare case of extrinsic compression of both coronary arteries after a Bentall procedure. A 50-year-old man with severe aortic valve stenosis, without coronary disease and an ascending aortic aneurysm, underwent a modified Bentall procedure with insertion of a valved tube and coronary re-implantation using surgical glue. Seven weeks later he suffered severe acute coronary ischemia and both coronary ostium were compressed by a dense and hard fibrose material. Three months after stenting, the patient required coronary surgery because of severe myocardial ischemia. Transesophageal and intracoronary ultrasounds were useful for the diagnosis of this rare complication.


CONCLUSIONS
Use of glue should be avoided for coronary reimplantation during Bentall surgery. In cases of external ostial compression by glue reaction, stenting may be ineffective and surgical coronary revascularization may be needed.
Cardiovascular Institute of Buenos Aires, Blanco Encalada 1543, (1428) Buenos Aires, Argentina. mstrivi@icba-cardiovascular.com.ar
Marcelo
M
Trivi
Jorge
J
Albertal
Guillermo
G
Vaccarino
Mariano
M
Albertal
Daniel
D
Navia
D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D023921:Coronary Stenosis / Q000209:etiology* / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D004338:Drug Combinations; D005557:Formaldehyde / Q000009:adverse effects*; D005780:Gelatin / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation; D006488:Hemostasis, Surgical / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012118:Resorcinols / Q000009:adverse effects*; D015607:Stents; D014014:Tissue Adhesives / Q000009:adverse effects*
D004338:Drug Combinations; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; D005557:Formaldehyde; D005780:Gelatin