Coronary thrombosis after Bentall’s procedure in a patient with Ehlers–Danlos syndrome: a case report

Acute coronary syndrome (ACS) following cardiac valve replacement is a rare but severe complication. Patients with vascular Ehlers-Danlos syndrome (vEDS) may exhibit an increased propensity for coronary thrombosis due to their genetic predisposition. After Bentall surgery, coronary manipulation and early postoperative anticoagulation instability may further contribute to thrombotic risk, particularly after mechanical valve implantation.

A 33-year-old male presenting with acute chest pain underwent a Bentall procedure for vEDS-complicated type A aortic dissection and received postoperative anticoagulation. Twenty days postoperatively, angiography and IVUS revealed a thrombus at the left anterior descending artery (LAD) ostium. Following a multidisciplinary discussion, percutaneous coronary intervention (PCI) was successfully performed to remove the thrombus and restore blood flow.

We discuss the risk of ACS following cardiac surgery, especially in vEDS patients, as well as strategies for early identification, timely intervention, and optimization of perioperative anticoagulation management.