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CASE20191115_002
| CORONARY - Chronic Total Occlusion | |
| Retrograde Recanalization of a Chronically Occluded Right Coronary Artery Through a Bentall Aortic Prosthesis | |
| Stylianos Pyxaras1 | |
| Landshut-Achdorf Hospital, Germany1, | |
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[Clinical Information]
- Patient initials or identifier number:
S.K.
-Relevant clinical history and physical exam:
1997, Bentall procedure due to massive aortic insufficiency and ascending aorta aneurysm, with re-implantation of the left main and venous grafting of the RCA.2000, re-operation for aortic valve replacement.2016, occlusion of the venous graft to the RCA.Since then stable angina and recurrent right heart failure, refractory to maximal medical treatment.
 angio_2016_1.mov Angio_2016_2.mov Ao.mov-Relevant test results prior to catheterization:
Cardiac MRI: massive hypoperfusion of the inferior wall, no scar, preserved ejection fraction.
MRI 1.mov MRI 2.mov- Relevant catheterization findings:
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[Interventional Management]
- Procedural step:
1. Retrograde wiring through epicardial collateral from the first diagonal using Suoh03 guide wire (Asahi Intecc, Nagoya, Japan) and Turnpike LP microcatheter (Teleflex Medical, Plymouth, MN, USA).2. Retrograde puncture of the Bentall prosthesis with an Astato XS 40 (Asahi Intecc, Nagoya, Japan), snaring of an RG3 in aorta and externalisation of the guidewire.3. Following aggressive dilatations of the point of wire exit using also Shockwave (Santa Clara, USA) implantation of 2 DES (due to extreme radial forces of recoil) with suboptimal final result.
4.mov 5.mov 6.mov- Case Summary:
¡ß The patient remains up to date asymptomatic and with complete remission of the heart failure symptoms. ¡ß Neo-ostial formation through Bentall prosthesis is feasible, but complete stent expansion remains an issue.
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