MASSIVE PERIGRAFT AORTIC-ANEURYSM LATE AFTER COMPOSITE GRAFT REPLACEMENT OF THE ASCENDING AORTA AND AORTIC-VALVE IN THE MARFAN-SYNDROME

A major complication of the Marfan syndrome is the development of a fusiform aneurysm of the ascending aorta involving both its sinus and tubular portions. The fusiform aneurysm generally leads to aortic regurgitation, which may become severe, or to aortic rupture, which nearly always is fatal. Treatment of the aneurysm and aortic regurgitation consists of insertion of a composite graft, which involves a substitute aortic valve being sewn into the proximal end of a tube graft. The composite graft is then anastomosed proximally at the aortic valve position and distally to the ascending aorta beyond the aneurysm, and the wall of the aneurysm of the native aorta is wrapped around the composite graft. The coronary arteries are directly anastomosed to small orifices in the tube graft (Bentall operation1). This report describes a patient who developed a massive perigraft aortic aneurysm late after operation. © 1993.