Giant Coronary Ostial Aneurysms after Aortic Root Replacement

Abstract

A 36-year-old man with Marfan’s Syndrome underwent aortic root replacement 21 years previously. A 29 mm St Jude valve conduit was used, anastomosing the coronary arteries to the composite valve graft using the ‘‘button’’ technique. He presented recently with worsening of long-standing back pain. As part of the investigations a CT angiogram was performed (Figure 1). This demonstrated aneurysms of the coronary buttons, (right 34 x 40 mm and left 19 x 17 mm) in the axial plane. It also demonstrated an infra-renal inflammatory abdominal aortic aneurysm, which was treated via open repair prior to the repeat cardiac surgery. An echocardiogram showed satisfactory function of the St Jude aortic valve. A redo sternotomy was performed and cardiopulmonary bypass established through the aorta and right atrium (Figure 2). The heart was protected by antegrade and retrograde cardioplegia. The two aneurysms were carefully dissected and then removed together with most of the original dacron graft leaving a small rim of dacron