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Late Coronary Ostial Stenosis After Complicated Bentall–De Bono Procedure

Year: 2025

Type: article

Abstract: BACKGROUND: Coronary ostial stenosis (COS) is a rare but potentially fatal complication following the Bentall-De Bono procedure. CASE SUMMARY: A 59-year-old man with prior Bentall-De Bono surgery along with venous graft reconstruction presented 8 years later with heart failure. Coronary computed tomography angiography demonstrated venous graft ostial stenosis, and cardiac magnetic resonance confirmed a transmural infarction with impaired ventricular function. Given the complex coronary anatomy and limitations to percutaneous treatment, the Heart Team opted for urgent surgical revascularization. DISCUSSION: COS after aortic root replacement results from multifactorial mechanisms, including surgical trauma, excessive tension, kinking, or fibrosis related to adhesives, whereas venous graft stenosis adds further complexity. Diagnosis is often challenging because coronary angiography may underestimate the disease while coronary computed tomography angiography and cardiac magnetic resonance offer superior anatomical and functional assessments, enabling accurate detection and guiding timely revascularization. TAKE-HOME MESSAGES: COS represents an uncommon yet life-threatening complication of aortic root replacement. Advanced multimodal imaging is pivotal to precise diagnosis and therapeutic guidance. Prompt, tailored revascularization strategies are essential to improving clinical outcomes.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105946