Treatment of impaired coronary blood flow after aortic root replacement with human tissue valves.

Aortic root replacement has been described extensively for aortic allograft or pulmonary autograft insertion.1,2 One of the critical issues of this technique is the correct reimplantation of the coronary artery buttons. Kinking or torsion of the coronary arteries may lead to intraoperative hemodynamic problems or to delayed symptoms including angina pectoris and/or limited exercise tolerance owing to impaired blood flow to the myocardium. We describe our experience with and treatment of coronary malperfusion in 4 patients who underwent aortic allograft or pulmonary autograft root replacement. Clinical summaries PATIENT 1. A 37-year-old woman underwent pulmonary autograft root replacement for aortic valve regurgitation resulting from healed native valve endocarditis. Preoperative coronary angiography showed normal coronary arteries. During the operation, a bicuspid noncalcified aortic valve was found. The ostium of the left coronary artery (LCA) was in its normal position, but the ostium of the right coronary artery (RCA) was displaced toward the noncoronary sinus.