Coronary ostial morphology after modified Bentall operation assessed with dual-source multidetector computed tomography

Abstract 

During the modified Bentall operation (aortic root replacement), a cuff of native aorta is commonly implanted together with the coronary ostium into the aortic graft. We describe the radiologic appearance on computed tomography of coronary-aortic and aorto-aortic graft anastomoses over long-term follow-up in 21 consecutive asymptomatic patients (mean age, 67 ± 12 years) with previous Bentall operation. Multidetector (64-slice, dual-source) computed tomography was performed at a median of 76 months after surgery. One patient had asymptomatic aortic dissection that extended into the carotid artery. Seven patients had aortic dilation ≥40 mm distal to the graft. All patients had dilation at the postsurgical coronary ostia-aortic attachment: mean coronary ostial diameter was 12.8 ± 3.6 mm, which was on average 1.7-fold greater than the adjacent proximal coronary vessel diameter. All patients had at least one ostium ≥10 mm in diameter. In 16 patients, both coronary ostia were ≥10 mm. There was no relationship between time after surgery and the ostial diameter. In patients with accessible presurgery angiograms, no relationship was observed between ostial diameters before and after surgery. Dilation of the coronary ostia anastomosis site is typical after the modified Bentall operation. Asymptomatic aortic pathology is also evident in this population.

Keywords: Aneurysm, Aortic operation, Computed tomograph, Coronary artery imaging