P692 Curious Bentall procedure complications, not always found in the immediate postoperative period

Ascending aorta aneurisms are often diagnosed in patients around 60-70 years old with prior history of hypertension or smoking, or in younger patients with connective tissue illnesses, such as Marfan Syndrome (MS), or bicuspide aortic valve (BAV). In patients with MS an aneurysm of the aortic root, ascending aorta or acute dissection are the most frequent reasons of death, that is why an aggressive surgical approach is recommended, by repairing or replacing the diseased aortic root. Prophylactic aortic root surgery is an effective procedure in preventing acute dissection and rupture with excellent long-term outcomes as published in the literature, being the Bentall procedure usually the treatment of choice. However, the implantation of a mechanic aortic prosthesis makes permanent oral anticoagulation necessary with elevated haemorragic risk. We present two peculiar cases of Bentall procedure with differentes indications, different scenarios but similar outcomes. - Case A: A 75-year-old female with MS who underwent Bentall surgery in 1988 due to a severe AR, stable and asymptomatic since then. In a routine check-up in November 2017, a dilatation of 65mm in her native ascending aorta was detected on a computed tomography scan (CT), visualizing a half-moon shaped space between the ascending aorta and the aortic tube of 21x46mm and a leak from de aorto-ostial union, being possible to confirm with the TEE its origin in the left coronary ostium, which was also dilated (10mm), due to a dehiscence in the aortic tube suture on that level. - Case B: A 43-year-old male who underwent Bentall surgery in 2014 due to a severe AR and aortic root aneurysm that in January 2017 was admitted to our hospital due to chest pain with no other symptoms associated. As part of the study and TTE, TEE and CT were performed in which a periaortic haematoma from de aortic root to the beginning of the aortic arch was found, visualizing a leak from a 5mm hole in the ostium of the right coronary artery. In addition, the left coronary artery had a severe stenosis (85%) due to the compression of the haematoma on that level. Even though the Bentall procedure has excellent outcomes we discovered unusual either long and short-term complications due to dehiscence of the sutures, causing a huge peri-prosthetic tube haematoma, compressing the left main coronary artery in one of our patients which was the cause of the angina he presented with. We think these images could help the diagnostic process in future cases since these complications are not only found in the immediate postoperative period and should always be in our minds. Abstract P692 Figure.