Revascularization of a Saphenous Vein Graft Ostial Stenosis in a Patient With Marfan Syndrome and a Previous Bentall Procedure Who was Resuscitated From Ventricular Fibrillation.

A 24-year-old male with Marfan syndrome was admitted following an episode of ventricular fibrillation (VF) during exercise. He had previously undergone multiple aortic surgical procedures for symptomatic aortic regurgitation and an ascending aortic false aneurysm. Ultimately, Bentall procedure and total arch replacement were performed, with a saphenous vein graft (SVG) anastomosed to the right coronary artery. Severe stenosis at the SVG ostium was identified, and ischemia in the inferior wall was suspected to be contributing to VF. Revascularization of the SVG stenosis by percutaneous coronary intervention (PCI) was deemed necessary despite its challenges. After confirming that a 4 Fr Judkins right (JR)-4 guiding catheter via the right femoral artery was suitable, a 6 Fr JR-4 guiding catheter was successfully engaged with the SVG. The SVG stenosis was crossed using a 0.014-in. guidewire, and drug-eluting stent implantation was successfully performed without complications. The patient's left ventricular ejection fraction improved, and no further ventricular arrhythmic events occurred after PCI. Marfan syndrome inherently carries a risk of fatal arrhythmia, and we emphasize that therapeutic management of myocardial ischemia is crucial, even in challenging PCI cases.