Very late dehiscence of a Bentall prosthesis

A 67-year-old patient presented with hypotension and new-onset chest pain irradiating towards the throat. He had a past history of DeBakey type II aortic dissection treated 20 years earlier by means of a Bentall procedure with insertion of a composite graft consisting of a single-leaflet mechanical valve into a Dacron graft. A few moments after arriving in the emergency room, he suddenly collapsed. Resuscitation was started and, since ECG showed widespread ST elevation, the decision was made to transfer the patient immediately to the cath-lab, while chest compressions were maintained by using a LUCAS Chest Compression System (Jolife, AB, Lund, Sweden). Via the right femoral approach, a right Judkins diagnostic catheter was introduced but, instead of engaging the right coronary artery, it seemed to enter a ‘blind hole’ where the injected dye remained stagnant (Fig. 1, arrow). Subsequently a pig-tail catheter was advanced to perform angiography of the aorta, which showed a dehiscence of the distal anastomosis of the previously implanted Dacron graft, resulting in widespread contrast extravasation into the peri-vascular space (Fig. 2). Because of the haemodynamic instability, urgent surgery did not seem to be an option. Therefore, we envisaged urgent implantation of an endovascular stent to cover the disruption, but unfortunately, while preparing the necessary interventional material, the patient died on the table.

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