[A case report of sudden death after Bentall's operation (Piehler's modification) due to left coronary occlusion].

We encountered a rare complication after Bentall's operation (Piehler's modification) with the left coronary artery occlusion. A 56-year-old man admitted to our hospital to get the aortic reconstruction operation for the chronic dissecting aortic aneurysm (DeBakey type I) with 7 cm in diameter. We performed Piehler's modification procedure using a 26 mm and 8 mm woven Dacron tubes coated with gelatin, and 23 mm prosthetic valve (St. Jude Medical). He got well after 6-day intubation until he complained anterior chest pain suddenly on 22 postoperative day. He showed ventricular fibrillation on the second attack requiring resuscitation procedures. Emergent angiogram showed total occlusion of the left coronary artery. The percutaneous transluminal coronary angioplasty was performed only with temporal success. Autopsy revealed no thrombus in the grafts and no kinking of the tubes. We might have to use more anticoagulants during the respirator assisted period when the APTT was naturally prolonged from 120 to 160 seconds.