title: Bilateral coronary ostial stenoses post-Bentall procedure causing hemodynamic collapse and requiring mechanical assist device placement: successful intervention using the Szabo technique.
abstract: Despite surgical advances, the Bentall procedure still carries a 2-6% rate of acute complications involving the coronary vessels, including ostial stenoses, kinking or pseudoaneurysm formation. We report an unusual case of a patient who developed acute cardiogenic shock within hours following a Bentall procedure, requiring urgent mechanical assist device support. Coronary angiography revealed significant bilateral coronary ostial stenoses; suggesting global cardiac hypoperfusion as the cause for this acute hemodynamic collapse. Given the disturbed coronary anatomy, the novel Szabo technique was used to accurately position and deploy an ostial right and then an ostial left main coronary stent, with excellent angiographic results. We conclude that even in situations with altered coronary anatomy, the Szabo technique should be considered for any patient requiring precise aorto-ostial stent placement.
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029, USA.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Kovacic
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
mesh_terms: D000792:Angiography / Q000379:methods; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography