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Arjomandi Rad A, Ansaripour A, Magouliotis DE, Abbasciano RG, Koulouroudias M, Viviano A, Rosendahl U, Athanasiou T, Kourliouros A. Surgical Strategies in Reoperation of the Proximal Aorta and Arch for Patients with Previous Frozen Elephant Trunk. J Clin Med 2024; 13:4063. [PMID: 39064105 PMCID: PMC11278031 DOI: 10.3390/jcm13144063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
Background: The frozen elephant trunk (FET) technique is increasingly utilized for aortic arch replacement in cases of aortic dissections and aneurysms. This rise in usage has led to more patients needing redo aortic surgeries due to progression of existing conditions, FET-related complications, or new valvular/coronary diseases. This article aims to evaluate surgical techniques to minimize risks during these reoperations, including a case study of a complex redo surgery. Methods: A comprehensive examination of surgical strategies was conducted, focusing on preoperative preparation, cannulation site identification, cerebral and cardiac protective measures, and pitfalls to avoid. The importance of adapting to the modified anatomical landscape post-FET is emphasized. A detailed case study of a patient undergoing complex redo FET surgery is included. Results: The article identified key surgical strategies for reoperation in patients with prior FET, highlighting the importance of meticulous preoperative planning and execution. Techniques to minimize risks include detailed imaging for planning, strategic cannulation for optimal perfusion, multidisciplinary approaches as well as careful fail-safe measures. The case study demonstrates the practical application of these strategies in a high-risk scenario. The evidence underscores the necessity for individualized patient management and the development of standardized protocols. Conclusions: The FET technique, while effective for initial aortic arch repairs, often necessitates complex reoperations. Adopting advanced surgical strategies and multidisciplinary planning can significantly mitigate risks associated with these procedures. Future research should focus on refining these techniques and establishing standardized protocols to improve patient outcomes.
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Affiliation(s)
- Arian Arjomandi Rad
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK;
| | - Ali Ansaripour
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK;
| | - Dimitrios E. Magouliotis
- Department of Cardiothoracic Surgery, University Hospital of Larissa, School of Medical Sciences, 413 34 Larissa, Greece;
| | - Riccardo G. Abbasciano
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK (A.V.); (T.A.)
| | | | - Alessandro Viviano
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK (A.V.); (T.A.)
| | - Ulrich Rosendahl
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK;
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK (A.V.); (T.A.)
| | - Antonios Kourliouros
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK;
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Recicarova S, Jonak M, Netuka I. Comprehensive multi-modality treatment of thoracic aorta pseudoaneurysms: a single-center experience. Gen Thorac Cardiovasc Surg 2024; 72:387-394. [PMID: 38001300 PMCID: PMC11127891 DOI: 10.1007/s11748-023-01986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Thoracic aorta false aneurysms (TAFA) are unexplored complications after cardiac surgery associated with significant morbidity and mortality. Therefore, the purpose of this study was to examine the clinical profiles, surgical techniques, and operative outcomes, of patients treated for TAFA at a single institution. METHODS From 1996 to 2022, 112 patients were treated for aortic pseudoaneurysm (mean age 55 ± 14 years, 78 patients were male). In the majority of the patients (90%) TAFA developed after previous cardiovascular surgery, the most common diagnosis and surgical procedure preceding the TAFA development was an aortic dissection (52%) and Bentall procedure (47%). In the rest of the cohort, the leading cause was trauma. RESULTS Sixty-one percent of patients were indicated for reintervention (surgical reoperation, endoluminal graft implantation, septal occluder implantation, coil embolization, or a combination of procedures). Overall, 52 patients had undergone cardiac reoperation. TAFA was resected and the aorta was repaired in 55% or replaced in 45%. Operative mortality was 5.7%. In postoperative follow-up, a hypoechogenic lesion encircling aortic prosthesis was present in 94%, therefore it was determined as a negative prognostic factor. The mean follow-up was 13.2 ± 19.4 years. CONCLUSION Although there is no specific approach how to prevent TAFA development, maintaining normal blood pressure and regular follow-up should be applied. More frequent follow-ups should be performed in patients with a hypoechogenic lesion encircling and aortic prosthesis. Early detection during long-term postoperative follow-up, an individually tailored approach of a multidisciplinary team is necessary for favorable treatment outcomes.
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Affiliation(s)
- Sandra Recicarova
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague, 140 00, Czech Republic.
- First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Michael Jonak
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague, 140 00, Czech Republic
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague, 140 00, Czech Republic
- Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Recicarova S, Chlup H, Jonak M, Netuka I. False aneurysms of the thoracic aorta: anastomosis investigation using the inflation-extension test. J Appl Biomed 2023; 21:174-179. [PMID: 38112456 DOI: 10.32725/jab.2023.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION False aneurysms in the thoracic aorta are dangerous complications that can occur after cardiac surgery. They often result in high mortality rates. These aneurysms are caused by damage to all layers of the aortic wall. This study aimed to pinpoint the area of the experimental specimen (native vessel, anastomosis, or prosthetic graft) with the greatest deformation, to determine whether a false aneurysm is likely to develop in the anastomotic portion. METHODS We conducted the inflation-extension test by performing eight cycles ranging from 0 to 20. The pressure sampling frequency was 100 Hz, and each cycle lasted approximately 34 seconds, resulting in a loading frequency of 0.03 Hz. During the experiment, each camera captured 3,000 frames. Based on the data collected, we evaluated and compared the loading stages of cycle 1 and cycle 8. RESULTS AND DISCUSSION During loading, the native vessel experienced a dominant deformation of approximately 7% in the circumferential direction. The prosthetic graft, which had a longitudinal construction, deformed by approximately 8% in the axial direction. The prosthetic graft, on the other hand, only experienced a deformation of up to 1.5% in the circumferential direction, which was about 5 times smaller than the deformation of the native vessel. The anastomosis area was very stiff and showed minimal deformation. Additionally, there was little difference in the mechanical response between the first C1 and the eighth C8 cycle. CONCLUSION Based on the available evidence, it can be inferred that aortic false aneurysms are more likely to form just behind the suture lines in the native aorta, which is more elastic compared to stiff sections of anastomosis and prosthetic graft. Numerous pulsations of the native vessel will likely cause the impairment of the aorta at the margin of the anastomosis. This will lead to disruption of the aortic wall and false aneurysm formation in the native vessel near the area of anastomosis.
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Affiliation(s)
- Sandra Recicarova
- Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiovascular Surgery, Prague, Czech Republic
- Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Hynek Chlup
- Czech Technical University, Faculty of Mechanical Engineering, Laboratory of Cardiovascular Biomechanics, Prague, Czech Republic
| | - Michael Jonak
- Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiovascular Surgery, Prague, Czech Republic
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiovascular Surgery, Prague, Czech Republic
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Zamani H, Vahidshahi K, Khalilian MR, Tahouri T, Rahimi-Movaghar E. Aortic Pseudoaneurysm following Ventricular Septal Defect Closure in a Pediatric Patient: A Case Report and Literature Review. Case Rep Cardiol 2023; 2023:2890844. [PMID: 38045862 PMCID: PMC10689068 DOI: 10.1155/2023/2890844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/10/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023] Open
Abstract
Aortic pseudoaneurysm, a rare condition characterized by localized transmural disruption and dilatation of the aorta, is very rare in the pediatric population. It is primarily caused by previous cardiovascular procedures such as aortic coarctation repair, aortic valve replacement, and subaortic membrane resection. We present a unique case of aortic pseudoaneurysm following surgery to repair a perimembranous ventricular septal defect in a 19-month-old boy who presented with fever as the sole symptom. The fever started on the 30th day after the surgery, and the patient exhibited abnormal laboratory results, including a white blood cell (WBC) count of 28.3 × 109/L, neutrophil percentage of 68%, platelet count of 880 × 109/L, erythrocyte sedimentation rate (ESR) of 200 mm/hour, and 3+ positive C-reactive protein. Echocardiogram revealed a large cystic mass (5 × 4.8 cm) in the ascending aorta, compressing the superior vena cava. Based on this finding, a diagnosis of aortic pseudoaneurysm was suspected. The diagnosis was confirmed through cardiac computed tomographic angiography, and the patient underwent emergent surgery for the repair of the aortic pseudoaneurysm under deep hypothermia and circulatory arrest. Unfortunately, our patient died shortly after the surgery.
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Affiliation(s)
- Hassan Zamani
- Shahid Modarres Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kourosh Vahidshahi
- Shahid Modarres Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Tahmineh Tahouri
- Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsanollah Rahimi-Movaghar
- Department of Surgery, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Science, Islamic Azad University, Tehran, Iran
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Tang T, Wu C, Liu J, Jian K, Liu W, Sheng W. Hypothermic Circulatory Arrest in Median Sternotomy Hemorrhage During Redo Aortic Surgery. Braz J Cardiovasc Surg 2023; 38:e20220164. [PMID: 37801053 PMCID: PMC10550102 DOI: 10.21470/1678-9741-2022-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 03/16/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION This study summarizes the clinical data of patients who developed sternotomy hemorrhage during redo aortic surgery and analyzes the clinical experience of using hypothermic circulatory arrest. METHODS We retrospectively analyzed the medical records of patients who developed sternotomy hemorrhage during redo aortic surgery from May 2018 to August 2021. General anesthesia with single-lumen tracheal intubation was used. Femoral artery, vein, and superior vena cava cannulation were used if cardiopulmonary bypass was required according to the situation, and right superior vein or apical cannulation was selected for left heart drainage. RESULTS A total of 11 patients were enrolled in this study, comprising nine males and two females, with an average age of 44.3±16.7 years. All cases were successfully completed without cerebrovascular complications or paraplegia. Two patients died during hospitalization, two patients died during the follow-up after discharge, and the remaining patients are recovering well. CONCLUSION The femoral-femoral bypass with hypothermic circulatory arrest technique is a safe and reliable method to use in cases of sternotomy hemorrhage during redo aortic surgery.
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Affiliation(s)
- Tiansheng Tang
- Department of Cardiovascular Surgery, The First Affiliated Hospital
of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu,
Anhui, People’s Republic of China
| | - Changjuan Wu
- Department of Pharmacy, Wannan Medical College, Wuhu, Anhui,
People’s Republic of China
| | - Jianshi Liu
- Department of Cardiovascular Surgery, DeltaHealth Hospital,
Shanghai, People’s Republic of China
| | - Kaitao Jian
- Department of Cardiovascular Surgery, DeltaHealth Hospital,
Shanghai, People’s Republic of China
| | - Wei Liu
- Department of Cardiovascular Surgery, DeltaHealth Hospital,
Shanghai, People’s Republic of China
| | - Weiyong Sheng
- Department of Cardiovascular Surgery, The First Affiliated Hospital
of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu,
Anhui, People’s Republic of China
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Suzuki T, Osada H, Takeda T, Yamazaki K, Minatoya K. Pseudoaneurysm arising from a side branch of a graft for ascending aortic replacement. JTCVS Tech 2023; 21:32-34. [PMID: 37854836 PMCID: PMC10580099 DOI: 10.1016/j.xjtc.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/11/2023] [Accepted: 06/27/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Tsutomu Suzuki
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroaki Osada
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahide Takeda
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Hegeman RRMJJ, Swaans MJ, Kara B, Heijmen RH, Smeenk HG, Timmers L, Sonker U, Klein P, Berg JMT. Transcatheter closure of postsurgical aortic pseudoaneurysms guided by three-dimensional image reconstruction: a single-centre experience. Neth Heart J 2023; 31:383-389. [PMID: 37256540 PMCID: PMC10516814 DOI: 10.1007/s12471-023-01784-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Postsurgical thoracic aortic pseudoaneurysms (PTAPs) are a potentially lethal complication after cardiac or aortic surgery. Surgical management can pose a challenge with high in-hospital mortality rates. Transcatheter closure is a less-invasive alternative treatment option for selected patients, although current experience is limited. AIMS We aimed to evaluate procedural and imaging outcomes of our first 11 cases of transcatheter PTAP closure with the use of closure devices. METHODS Patients with a high operative risk who underwent transcatheter PTAP closure at our centre from 2019 to 2021 were retrospectively included. Suitability was evaluated on preprocedural computed tomography (CT) scans and three-dimensional (3D) reconstructions. All procedures were performed in the catheterisation laboratory. Intraprocedural aortography and postprocedural CT scans with 3D reconstructions were used to evaluate PTAP occlusion. RESULTS Eleven consecutive patients with a high operative risk and a history of cardiac/aortic surgery who underwent transcatheter PTAP closure were included. PTAPs were predominantly located at the proximal or distal anastomosis of a supracoronary ascending aortic vascular graft or Bentall prosthesis (82%). Implanted closure devices included Amplatzer Valvular Plug III (82%), Amplatzer septal occluder (9%) and Occlutech atrial septal defect occluder (9%). No periprocedural complications occurred. After device deployment, residual flow was absent on aortography in 64% and minimal residual flow was present in 36% of patients. Subtotal or total occlusion of the PTAP on follow-up CT ranged between 45% and 73%. CONCLUSIONS Although subtotal or total occlusion of the PTAP was found at follow-up in only 45-73% of cases, transcatheter PTAP closure guided by preprocedural 3D reconstructions can offer a valuable minimally invasive primary treatment option for patients who otherwise would face a high-risk reoperation.
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Affiliation(s)
- Romy R M J J Hegeman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Basak Kara
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hans G Smeenk
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Leo Timmers
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Uday Sonker
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Lee J, Lim HA, Hong SB, Kim DY, Kim YH, Kim HW. Granulomatous inflammation mimicking a hematoma around the replaced ascending aorta in magnetic resonance imaging: a case report. J Cardiothorac Surg 2023; 18:191. [PMID: 37312122 DOI: 10.1186/s13019-023-02298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/27/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Granulomatous inflammation results from various causes including infections and allergic reactions. It can appear as high signal intensity in T2-weighted or contrast-enhanced T1-weighted magnetic resonance imaging (MRI). Here, we describe a case of granulomatous inflammation looking like a hematoma on an ascending aortic graft in MRI. CASE PRESENTATION A 75-year-old female was undergoing assessment for chest pain. She had a history of hemi-arch replacement for aortic dissection 10 years earlier. The initial chest computed tomography and subsequent chest MRI were suggestive of a hematoma, implying a pseudoaneurysm of the thoracic aorta, which is associated with high mortality in reoperation. Through redo median sternotomy, severe adhesion was found in the retrosternal space. A sac in the pericardial space contained yellowish and pus-like material, confirming that there was no hematoma around the ascending aortic graft. The pathologic finding was chronic necrotizing granulomatous inflammation. Microbiological tests including polymerase chain reaction analysis were negative. CONCLUSION Our experience indicates that an MRI finding of a hematoma at the site long after cardiovascular surgery suggests that there may be granulomatous inflammation.
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Affiliation(s)
- June Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Hyun Ah Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seok Beom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
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Onyemkpa C, Coselli JS. Endovascular exclusion of ascending aortic pseudoaneurysm with an experimental ascending aortic stent-graft. JTCVS Tech 2023; 19:18-21. [PMID: 37324324 PMCID: PMC10268502 DOI: 10.1016/j.xjtc.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Chibueze Onyemkpa
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- The Texas Heart Institution, Houston, Tex
| | - Joseph S. Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- The Texas Heart Institution, Houston, Tex
- CHI St Luke's Health–Baylor St Luke's Medical Center, Houston, Tex
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex
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10
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Doenst T, Gaudino MF. Commentary: Hear no evil, see no evil-except with 4-dimensional cardiac computed tomography! J Thorac Cardiovasc Surg 2023; 165:1298-1299. [PMID: 34049706 DOI: 10.1016/j.jtcvs.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Mario F Gaudino
- Department of Cardiothoracic Surgery at New York Presbyterian, Weill Cornell Medical Center, New York, NY.
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11
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Surgical management of ascending aorta pseudoaneurysm in a patient with COVID-19. COR ET VASA 2023. [DOI: 10.33678/cor.2022.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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12
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Rizza A, Negro F, Scalera S, Palmieri C, Santoro G, Berti S. Total Endovascular Treatment of Ascending Aorta Pseudoaneurysm After Bentall Procedure. JACC: CASE REPORTS 2023; 10:101764. [PMID: 36974053 PMCID: PMC10039386 DOI: 10.1016/j.jaccas.2023.101764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 03/17/2023]
Abstract
Ascending aorta pseudoaneurysms represent uncommon but life-threatening complications that can be observed even after a long time in patients who have undergone aortic surgery. We describe an interesting case of a patient with ascending aorta pseudoaneurysm after the Bentall procedure treated with endovascular coil embolization from the right coronary artery. (Level of Difficulty: Intermediate.).
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13
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Ascending Aortic Pseudoaneurysm Following Aortic Valve Replacement: A Case Report and Literature Review. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2022. [DOI: 10.5812/intjcardiovascpract-133752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction: Ascending aortic pseudoaneurysm (AAP) rupture is a surgical emergency that needs immediate medical and surgical attention and treatment. This rupture can be caused by a variety of risk factors. Prior cardiovascular surgery is a common cause, and prior aortic valve operation is a rare cause. Case Presentation: In this case report, we describe a 47-year-old male with AAP who had a history of aortic valve replacement because of aortic stenosis.
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14
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Eltayeb A, Khan S, Dib S, Musthaq A, Elshaer A, Shaik A, Galzerano D, Fadel B, Aladmawi M, Vriz O. Three-dimensional printing in integrated multi-modality imaging approach for management of prosthetic valves infective endocarditis. Monaldi Arch Chest Dis 2022; 93. [PMID: 36426901 DOI: 10.4081/monaldi.2022.2479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
Abstract
After heart failure, infectious endocarditis is the second leading cause of death in patients with prosthetic valves. Aortic pseudoaneurysms are a serious complication of infective endocarditis in mechanical or bioprosthetic aortic prostheses. Diagnostic and management challenges are posed by aortic pseudoaneurysms. In these cases, a multi-modality imaging approach with a heart team is recommended. We described two cases of aortic pseudoaneurysms that developed as a result of infective endocarditis. The first case involved a TAVI patient who developed infective endocarditis as a result of diabetic foot complications. Because traditional echocardiography and computed tomography failed to show the anatomy of the lesion, we used 3D printing to show the anatomy, extension of the pseudoaneurysm, and proximity to the right coronary artery. The second case involved a patient who underwent Bentall's surgery with an aortic root and mechanical aortic valve and later developed infective endocarditis complicated by pseudoaneurysms. In this case, 3D printing was used for preoperative surgical planning.
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Affiliation(s)
- Abdalla Eltayeb
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Shahid Khan
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Salam Dib
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Ali Musthaq
- College of Medicine, Alfaisal University, Riyadh.
| | | | | | - Domenico Galzerano
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Bahaa Fadel
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Mohamed Aladmawi
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Olga Vriz
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh.
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15
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Barbosa Lima GB, Ocasio L, Tenorio ER, Neto MD, Macedo TA, Oderich GS. Endovascular Repair of Aortic Arch Graft Pseudoaneurysm using a Duct Occluder Device with On-lay Fusion Guidance. J Vasc Surg Cases Innov Tech 2022; 8:708-709. [DOI: 10.1016/j.jvscit.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/11/2022] [Indexed: 11/24/2022] Open
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16
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Saul D, Kandula V, Donuru A, Pizarro C, Harty MP. Large aortic pseudoaneurysm after Bentall procedure in a patient with Marfan's syndrome. Ann Pediatr Cardiol 2022; 15:314-316. [PMID: 36589649 PMCID: PMC9802612 DOI: 10.4103/apc.apc_113_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/30/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
An 11-year-old male with Marfan's syndrome and aortic root dilatation underwent an uneventful Bentall procedure to replace his aortic root and valve. Five months later, surveillance echocardiogram revealed a slowly enlarging pseudoaneurysm arising from the ascending aorta. This finding was subsequently confirmed by computed tomographic angiogram. The patient had successful open surgical repair and paraaortic hematoma evacuation.
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Affiliation(s)
- David Saul
- Department of Medical Imaging, A. I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Vinay Kandula
- Department of Medical Imaging, A. I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Achala Donuru
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Christian Pizarro
- Department of Surgery, Division of Cardiothoracic Surgery, A. I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Mary Patricia Harty
- Department of Medical Imaging, A. I. DuPont Hospital for Children, Wilmington, DE, USA
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17
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Shimada A, Yamamoto T, Endo D, Nishida K, Matsushita S, Asai T, Amano A. Pseudoaneurysm with a fistula to the right ventricle late after surgical repair of type A aortic dissection in a patient with systemic lupus erythematosus. J Cardiothorac Surg 2022; 17:83. [PMID: 35477534 PMCID: PMC9044762 DOI: 10.1186/s13019-022-01827-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pseudoaneurysm with a shunt to the right ventricle after aortic repair for acute aortic dissection is an extremely rare and life-threatening condition. Surgical treatment is unavoidable, but surgery is complicated, and there are some pitfalls. This study describes the reoperation performed in a patient at a high surgical risk by clarifying the shunt site using multimodality imaging before surgery. Case presentation A 69-year-old woman with a history of systemic lupus erythematosus (SLE) and Sjogren’s syndrome presented with a pseudoaneurysm 1 year after emergency surgery for acute type A aortic dissection. Eight years after the first surgery, she experienced sudden chest pain and presented to the emergency department. Her dyspnea worsened; therefore, echocardiography and three-dimensional computed tomography (3DCT) were performed, and a pseudoaneurysm and shunt to the right ventricle were identified. The medical team attempted to close the shunt with a percutaneous catheter but was unsuccessful, and she was referred to our department for surgical treatment. The pseudoaneurysm originating from the proximal side of the aorta was large (diameter = 55 mm), and echocardiography-gated 3DCT identified the shunt from the pseudoaneurysm to the right ventricle. First, extracorporeal circulation was initiated, and resternotomy was performed. We could not insert the left ventricular venting tube from the right side because of the pseudoaneurysm size. Instead, the tube was inserted from the left atrial appendage. We found a half-circumferential disengaged anastomosis around the proximal anastomosis, which formed the large pseudoaneurysm leading to a fistula in the right ventricle. We closed the fistula and performed a Bentall operation. The patient had a good postoperative course and was discharged on postoperative day 21. She continued treatment for SLE and Sjogren’s syndrome, and her inflammatory reaction improved. Conclusions We performed a Bentall operation and fistula closure with resternotomy in a patient with type A aortic dissection with SLE and Sjogren’s syndrome. Multimodal imaging is essential in defining the pseudoaneurysm and the fistula surrounding the anatomy while ensuring their resolution and guiding the approach for operation.
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Affiliation(s)
- Akie Shimada
- Department of Cardiovascular Surgery, Nerima Hospital, Juntendo University, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Nerima Hospital, Juntendo University, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan.
| | - Daisuke Endo
- Department of Cardiovascular Surgery, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Kousuke Nishida
- Department of Cardiovascular Surgery, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Satoshi Matsushita
- Department of Cardiovascular Surgery, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University, Bunkyo-Ku, Tokyo, Japan
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18
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Chaud GJ, Mohammadi S, Cervetti MR, Guimaron S, Sebestyen A, Dagenais F, Dumont E. Aortic Pseudoaneurysm After Type A Aortic Dissection: Results of Conservative Management. Semin Thorac Cardiovasc Surg 2022; 35:457-464. [PMID: 35430352 DOI: 10.1053/j.semtcvs.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 01/01/2023]
Abstract
Aortic pseudoaneurysms after acute Type A aortic dissection (ATAAD) repair have been reported as high as 10-24% and surgical treatment is usually recommended. The objective of this article is to examine the safety and efficacy of a conservative approach to aortic pseudoaneurysm and to compare this approach to standard surgical treatment. We retrospectively examined 39 patients who had an aortic pseudoaneurysm after ATAAD surgery in order to examine outcomes (baseline characteristics, presentation and freedom from aortic events and mortality). We initially identified 31 patients treated conservatively (CT). After close follow up, 5 of them were operated so 13 patients were treated surgically (ST) and analyzed at a long-term follow-up while 26 were in the conservative group. Mean follow- - up of the whole cohort was 7.9 ± 5.9 years. The freedom from aortic-related mortality at 1, 5, and 10 years was 100%, 83.3% and 72.9% for the ST group and 95.8%, 77.3%, and 77.3% for the CT group (P = 0.35). A conservative approach to aortic pseudoaneurysms could be justified in asymptomatic patients. A close follow-up by a dedicated aortic clinic is mandatory so that patients are referred for surgery when necessary.
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Affiliation(s)
- German J Chaud
- Department of Cardiac Surgery, Cardiac Surgery Service, Quebec Heart and Lung Institute, Laval University, 725, chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - Siamak Mohammadi
- Department of Cardiac Surgery, Cardiac Surgery Service, Quebec Heart and Lung Institute, Laval University, 725, chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - Manuel Roque Cervetti
- Department of Cardiac Surgery, Cardiac Surgery Service, Quebec Heart and Lung Institute, Laval University, 725, chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - Samantha Guimaron
- Department of Cardiac Surgery, Cardiac Surgery Service, Quebec Heart and Lung Institute, Laval University, 725, chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - Alexandre Sebestyen
- Department of Cardiac Surgery, Cardiac Surgery Service, Quebec Heart and Lung Institute, Laval University, 725, chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - François Dagenais
- Department of Cardiac Surgery, Cardiac Surgery Service, Quebec Heart and Lung Institute, Laval University, 725, chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - Eric Dumont
- Department of Cardiac Surgery, Cardiac Surgery Service, Quebec Heart and Lung Institute, Laval University, 725, chemin Ste-Foy, Quebec, QC G1V 4G5, Canada.
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19
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McClure GR, Ratnayake G, Chan A, Gagnon J. Percutaneous closure of a post-surgical ascending aortic pseudoaneurysm with an amplatzer septal occluder device and steerable guiding sheath. Catheter Cardiovasc Interv 2021; 98:E985-E989. [PMID: 34586756 DOI: 10.1002/ccd.29951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022]
Abstract
Thoracic pseudoaneurysm in the ascending aorta is an uncommon condition associated with significant risk of morbidity and mortality. Treatment is recommended in all cases regardless of symptoms as the mortality rate if left untreated has been documented to be as high as 61%. The current standard of care for managing these lesions is open surgical repair. However, this is associated with significant morbidity. In-hospital mortality reported for patients undergoing surgical repair of an ascending aortic pseudoaneurysm ranges from 6.7% to 41%. When anatomically suitable, a less invasive approach using amplatzer vascular plug or septal occluder is an attractive approach. We present a case report of repair of a post-surgical ascending aortic false aneurysm using an amplatzer septal occluder with an Oscor ™ steerable guiding sheath; a novel approach to increase platform stability when engaging an aneurysm neck. Endovascular occluder deployment for closure of aortic false aneurysms remains a relatively novel technique. It is limited by the requirement to develop a stable endovascular platform to deliver the device and avoid system prolapse, particularly when accessing challenging lesions on the inner aortic curvature. We present the first case to utilize a steerable guiding sheath system to improve system stability and facilitate successful device delivery. Given the significant morbidity associated with open repair of these lesions we hope this will further expand the range of lesions viewed as appropriate for endovascular repair.
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Affiliation(s)
- Graham R McClure
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Geemitha Ratnayake
- Michael G Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Albert Chan
- Department of Medicine, University of British Columbia, New Westminster, British Columbia, Canada.,Division of Interventional Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Joel Gagnon
- Department of Surgery, University of British Columbia, New Westminster, British Columbia, Canada.,Division of Vascular Surgery, Royal Columbian Hospital, New Westminster, British Columbia, Canada
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20
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Hanna Quesada F, Hanna Rodríguez F, Moroni F, Marín A, Nieto J, Mejía D, Castrillon J, Harada Ribeiro M, Palma Dallan LA, Campos CAHM, Salazar S, Azzalini L. Emergent endovascular repair of a ruptured ascending aorta pseudoaneurysm with thoracic aortic stent graft. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:167-169. [PMID: 34304996 DOI: 10.1016/j.carrev.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
Pseudoaneurysm of the ascending aorta is a rare complication of cardiac surgery due to tissue degeneration at the site of graft anastomosis, aortotomy, or extracorporeal circulation cannulation. We describe the case of a patient who developed an ascending aorta pseudoaneurysm after coronary artery bypass graft surgery, which initially required percutaneous closure with an atrial septal defect occlusion device. However, three years later the patient presented again with active external bleeding secondary to pseudoaneurysm enlargement and rupture, which was emergently repaired by percutaneous endovascular repair with a thoracic aortic stent graft. At one-year follow-up the patient is in good conditions and asymptomatic.
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Affiliation(s)
| | | | - Francesco Moroni
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Andrés Marín
- Interventional Cardiology Division, Clínica Comfamiliar Pereira, Colombia
| | - James Nieto
- Interventional Cardiology Division, Clínica Comfamiliar Pereira, Colombia
| | - Diego Mejía
- Interventional Cardiology Division, Clínica Comfamiliar Pereira, Colombia
| | - Jhon Castrillon
- Interventional Cardiology Division, Clínica Comfamiliar Pereira, Colombia
| | | | - Luis Augusto Palma Dallan
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Carlos Augusto H M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil; The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Instituto Prevent Senior, Sao Paulo, Brazil
| | - Santiago Salazar
- Interventional Cardiology Division, Clínica Comfamiliar Pereira, Colombia
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
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21
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Mehta AR, Hammond B, Unai S, Navia JL, Gillinov M, Pettersson GB. Percutaneous cardioplegic arrest before repeat sternotomy in patients with retrosternal aortic aneurysm. J Thorac Cardiovasc Surg 2021; 161:1724-1730. [DOI: 10.1016/j.jtcvs.2019.09.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/22/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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22
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Weferling M, Haas M, Hamm CW. Transradial Closure of a Large Ascending Aortic Pseudoaneurysm With a Duct Occluder II - A Case Report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:61-64. [PMID: 33935002 DOI: 10.1016/j.carrev.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022]
Abstract
Pseudoaneurysm of the ascending aorta is a rare but potentially life-threatening complication of cardiothoracic surgery. Re-operation is associated with a high mortality risk; therefore, percutaneous endovascular closure techniques with different closure devices have been repeatedly reported over the last 15 years. Previous endovascular procedures were performed using a transfemoral or transbrachial approach. We report a case of transradial ascending aortic pseudoaneurysm closure in a patient deemed unsuitable for surgery.
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Affiliation(s)
- Maren Weferling
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner site RheinMain, Frankfurt, Germany.
| | - Moritz Haas
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - Christian W Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner site RheinMain, Frankfurt, Germany; University Hospital of Giessen, Department of Cardiology, Giessen, Germany
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23
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Moyano-Portillo Á, Garrido-Márquez I, Pérez-Naranjo P, Moya-Sánchez E, Martín-Rodríguez JL. Pseudoaneurismas aórticos en cáncer de pulmón: una entidad infrecuente. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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24
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Zivkovic I, Stankovic S, Krasic S, Peric M, Stojanovic I. Surgical Treatment of Pseudoaneurysm of the Ascending Aorta in a Patient with Sepsis. Braz J Cardiovasc Surg 2021; 36:261-264. [PMID: 33355802 PMCID: PMC8163267 DOI: 10.21470/1678-9741-2020-0258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pseudoaneurysm of the ascending aorta (PAA) is a hazardous and potentially fatal cardiovascular disease. This condition is caused by the rupture of at least one layer of the vessel and contained by the remaining vascular layers or the surrounding mediastinal structures. We presented the surgical treatment of a patient with sepsis and large PAA and brachiocephalic trunk, which was compressing the brachiocephalic trunk leading to syncope.
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Affiliation(s)
- Igor Zivkovic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Stefan Stankovic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Stasa Krasic
- Department of Cardiology, Mother and Child Health Institute of Serbia, Belgrade, Serbia
| | - Miodrag Peric
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Ivan Stojanovic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
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25
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Brown JA, Sultan I. Temporary TEVAR as a bridge to open aortic pseudoaneurysm repair. J Card Surg 2021; 36:1157-1158. [PMID: 33522618 DOI: 10.1111/jocs.15381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Affiliation(s)
- James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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26
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Blitzer D, Nguyen SN, Patel V, George I, Takayama H. Hybrid repair of ascending aortic pseudoaneurysm. J Card Surg 2021; 36:1154-1156. [PMID: 33522617 DOI: 10.1111/jocs.15388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/07/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022]
Abstract
For ascending aortic pseudoaneurysms with a large aortic entry site and thrombus burden, temporary stent-graft placement at induction of circulatory arrest can prevent thrombotic complication.
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Affiliation(s)
- David Blitzer
- Department of Surgery, Columbia University, New York, New York, USA
| | | | - Virendra Patel
- Department of Surgery, Columbia University, New York, New York, USA
| | - Isaac George
- Department of Surgery, Columbia University, New York, New York, USA
| | - Hiroo Takayama
- Department of Surgery, Columbia University, New York, New York, USA
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27
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Recurrent ascending aortic pseudoaneurysms: rare but a feared complication. Indian J Thorac Cardiovasc Surg 2021; 37:334-337. [PMID: 33967426 DOI: 10.1007/s12055-020-01081-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022] Open
Abstract
Presenting a case of recurrent ascending aortic pseudoaneurysms following emergency type A aortic dissection. It is a rare complication of aortic surgery but once diagnosed; especially in patients with suspected mycotic infection, it necessitates high-risk early surgical interventions.
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28
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Takahara Y, Nishiki K, Nakase K, Mizuno S. Ruptured pseudoaneurysm of the thoracic aorta mimicking lung cancer: A case report. Thorac Cancer 2021; 12:685-689. [PMID: 33421335 PMCID: PMC7919164 DOI: 10.1111/1759-7714.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
A 70‐year‐old woman was admitted to a local hospital with a five‐day history of back pain. She had been referred to our hospital after an abnormal chest shadow was identified on chest X‐ray. Chest computed tomography (CT) revealed an anterior mediastinal mass in the upper lobe of the left lung. Her general condition was good. She was diagnosed with lung cancer, and examination was planned. However, respiratory failure rapidly worsened on hospital day 2, and a ruptured pseudoaneurysm of the thoracic aorta (PTA) was diagnosed from contrast‐enhanced CT. Emergency thoracic endovascular aortic repair was successfully performed, and her postoperative course was uneventful. The hemodynamics of the PTA were stable in the case of this patient, but the risk of rupture is extremely high and frequently fatal. PTA should therefore be included among the differential diagnoses of mediastinal tumor. Key points Significant findings of the study Pseudoaneurysm of the thoracic aorta (PTA) may present on imaging findings that resemble lung cancer. What this study adds PTA should be included among the differential diagnoses of mediastinal tumor. Clinicians therefore need to be familiar with the imaging findings of PTA.
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Affiliation(s)
- Yutaka Takahara
- Department of Respiratory Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Kazuaki Nishiki
- Department of Respiratory Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Keisuke Nakase
- Department of Respiratory Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Shiro Mizuno
- Department of Respiratory Medicine, Kanazawa Medical University, Kahoku-gun, Japan
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29
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Alsatli R, AlHalees Z, Kholaif N. Postcardiosurgical pseudoaneurysm. Anesth Essays Res 2021; 15:338-340. [PMID: 35320961 PMCID: PMC8936863 DOI: 10.4103/aer.aer_140_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/02/2022] [Indexed: 11/04/2022] Open
Abstract
Takayasu's arteritis is an autoimmune inflammatory disease of large arteries. We report a case of postcardiac surgery pseudoaneurysm. Anesthetic concerns, high risk related to surgery, necessary anesthetic preparations, and considerations will be mentioned here.
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30
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Iatrogenic Ascending Aortic Pseudoaneurysm: A Scarcy Bomb After Coronary Artery Bypass Surgery. COR ET VASA 2020. [DOI: 10.33678/cor.2020.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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31
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Chen S, Smith DE, Lester L, Galloway AC. Surgical management of a pulsatile chest wall mass secondary to an ascending aortic aneurysm in a patient with bovine arch. J Card Surg 2020; 36:315-317. [PMID: 33029798 DOI: 10.1111/jocs.15104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
Ascending aortic pseudoaneurysms are rare, but life-threatening conditions, that often require intervention. While endovascular techniques have advanced significantly, the majority of these clinical scenarios preclude endovascular options and the primary treatment modality remains open surgical repair. Repair of an aortic pseudoaneurysm eroding through the sternum resulting in a pulsatile chest wall mass is technically challenging. We report the successful repair of a large ascending aortic pseudoaneurysm in a 62-year-old male with bovine arch anatomy and prior Type A dissection repair, presenting with contained rupture and a pulsatile chest wall mass.
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Affiliation(s)
- Stacey Chen
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA
| | - Deane E Smith
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA
| | - Lynette Lester
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA
| | - Aubrey C Galloway
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA
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32
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Chiocchi M, Spiritigliozzi L, Di Tosto F, Benelli L, D'Errico F, Presicce M, Pugliese L, Ricci F, De Stasio V, Di Donna C, Pasqualetto M, Colella DF, Floris R. Ascending aorta pseudoaneurysm simulating mediastinal lymphoma in computed tomography, a possible diagnostic error: a case report. J Med Case Rep 2020; 14:167. [PMID: 32972458 PMCID: PMC7517812 DOI: 10.1186/s13256-020-02465-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/27/2020] [Indexed: 12/03/2022] Open
Abstract
Background An ascending aortic pseudoaneurysm is a severe and rare complication following cardiothoracic surgery. This case report demonstrates its possible misinterpretation and the consequent importance of multidisciplinary evaluation. Case presentation We present a case of an 18-year-old Caucasian man with Marfan syndrome who developed an ascending aortic pseudoaneurysm about 1 year after undergoing cardiac surgery with the Bentall procedure. Computed tomographic examination of the thoracic aorta and positron emission tomography–computed tomography initially suggested a lymphomatous pathology. However, these imaging results were in contrast to the transesophageal echocardiogram and the laboratory data that showed negative results for hematological pathology. A second computed tomographic scan redirected the diagnosis toward a pseudoaneurysm. Conclusion This case demonstrates the utility of close communication and interdisciplinary consultation between cardiovascular radiologists and the cardiac surgery team, which are mandatory in order to maximize their diagnostic skills in identifying postoperative complications.
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Affiliation(s)
- Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
| | - Luigi Spiritigliozzi
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy.
| | - Federica Di Tosto
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
| | - Leonardo Benelli
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
| | - Francesca D'Errico
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
| | - Matteo Presicce
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
| | - Luca Pugliese
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
| | - Francesca Ricci
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
| | - Vincenzo De Stasio
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
| | - Carlo Di Donna
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
| | - Monia Pasqualetto
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
| | - Dionisio Ferdinando Colella
- Cardiothoracic Anesthesiology PTV Foundation, "Tor Vergata" Hospital University of Rome "Tor Vergata" Viale Oxford, 81-00133, Rome, Italy
| | - Roberto Floris
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy
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33
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Raju SN, Shaw M, Pandey NN, Sharma A, Kumar S. Imaging evaluation using computed tomography after ascending aortic graft repair. Asian Cardiovasc Thorac Ann 2020; 29:132-142. [PMID: 32957798 DOI: 10.1177/0218492320960331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prosthetic aortic graft repair is employed in the management of various conditions such as annuloaortic ectasia, ascending aortic aneurysm, type A aortic dissection, and aortic root abscess. Correct interpretation of post-surgical prosthetic graft complications requires familiarity with the expected normal cross-sectional imaging appearance as well knowledge of additional surgical materials used in the repair, which could influence the imaging appearance. Multiple life-threatening complications of a prosthetic ascending aortic graft can be seen in the aorta and vicinity of the operative field. Complications can arise from involvement of the prosthetic aortic graft per se or secondary involvement of the coronary arteries, mediastinum, and sternotomy site. The optimal imaging protocol using multidetector computed tomography allows accurate interpretation of the expected benign postoperative changes as well as complications associated with the prosthetic graft, and differentiation of true complications from their mimickers. This review focuses on the normal imaging appearance of a prosthetic aortic graft on multidetector computed tomography, and imaging evaluation of multiple post-surgical complications that could arise after repair of the ascending aorta and the aortic valve.
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Affiliation(s)
- Sreenivasa Narayana Raju
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Shaw
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Stamou SC, Conway BD, Nores MA. Management of Aortic Pseudoaneurysms: Evolving Concepts and Controversies. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2020; 8:1-5. [PMID: 32599626 PMCID: PMC7324250 DOI: 10.1055/s-0039-1700999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background
Techniques to repair aortic pseudoaneurysms have been rapidly evolving. We present our results following open and endovascular repair of aortic pseudoaneurysms from 2009 to 2013.
Methods
A total of nine patients underwent pseudoaneurysm repair from April 2009 to February 2013. Of them, five underwent open repair and four underwent endovascular repair. The median age was 58 years (range, 40–72 years) and two (22%) were females. Preoperative, operative, and postoperative data are presented along with operative modality.
Results
Two patients died during the period of study. Patient 1 died from massive hemorrhage at the site of prior stenting. Patient 7 died from postoperative cardiac arrest and respiratory failure. A single patient required hemorrhage-related reexploration. None of the patients experienced stroke or acute renal failure following repair. Median hospital and intensive care unit length of stays were 7.1 (range, 1–20) and 2.0 (range, 1–5), respectively.
Conclusions
Pseudoaneurysm repair can be effectively achieved through open or percutaneous repair but only after careful consideration of anatomical constraints, as well as patient comorbidities.
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Affiliation(s)
- Sotiris C Stamou
- Department of Cardiothoracic Surgery, John Fitzgerald Kennedy Medical Center, Atlantis, Florida
| | - Brian D Conway
- Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Marcos A Nores
- Department of Cardiothoracic Surgery, John Fitzgerald Kennedy Medical Center, Atlantis, Florida
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35
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Stefanelli G, Pirro F, Macchione A, Bellisario A, Weltert L. Long-term follow-up after Bentall operation using a stentless Shelhigh NR-2000 bio-conduit. J Card Surg 2020; 35:988-995. [PMID: 32176376 DOI: 10.1111/jocs.14510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND To analyze the long-term results after Bentall operation using the stentless Shelhigh No-React (NR)-2000 bio-root prosthesis. MATERIAL From 2004 to 2008, 26 consecutive, nonselected patients (mean age at surgery: 67 ± 9 years) underwent a Bentall operation using a stentless Shelhigh valved conduit at our institution. Mean preoperative Logistic-EuroSCORE was 17.1 ± 12.9. The mean size of the aortic root was 53.2 ± 5 mm. The mean preoperative ejection fraction was 55 ± 7.4%. Three patients had a bicuspid valve. One patient with acute endocarditis and one patient with type A aortic dissection were operated on an emergency. Three patients (11.54%) had a previous cardiac operation. The Button-Bentall technique was used in all cases. Seven patients (26.92%) received an associated procedure. The mean size of the implanted prosthesis was 26.1 ± 2.2. Follow-up ranged between 6 and 174 months (mean 93.4 ± 59.1 months). Primary endpoints consisted of early and late mortality, freedom from acute endocarditis, freedom from structural valve deterioration, and freedom from valve-related-reoperation. RESULTS Two patients died in hospital, while 10 patients died during follow-up time, of which three for cardiac causes (12.5%). Overall survival probability was 52.9% at 15 years. Freedom from acute endocarditis was 95.7% at 5 and 15 years. Freedom from severe aortic incompetence due to structural deterioration was 100% at 5 and 10 years, 90.9% at 15 years. The mean aortic gradient at follow-up was 11.4 ± 5 mm Hg. Freedom from valve-related reoperation was 100% at 5 and 10 years, 90.9% at 15 years. CONCLUSIONS In our experience, Bentall's operation using the Shelhigh NR-2000 stentless bio-conduit provided satisfactory early and long-term results. However, our findings are not consistent with unfavorable long-term outcomes following the implantation of this device reported by other authors.
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Affiliation(s)
| | - Fabrizio Pirro
- Department of Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | | | | | - Luca Weltert
- Department of Cardiac Surgery, European Hospital, Rome, Italy
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36
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Carmans L, De Meester P, Budts W, Troost E. Percutaneous closure of an uncommon aortic pseudoaneurysm after arterial switch repair: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 3:1-4. [PMID: 32099960 PMCID: PMC7026597 DOI: 10.1093/ehjcr/ytz178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/21/2018] [Accepted: 09/25/2019] [Indexed: 11/18/2022]
Abstract
Background The development of an aortic pseudoaneurysm is a rather rare but potentially fatal complication after cardiac surgery for aortic valve and aorta disease. If a pseudoaneurysm is left untreated, it carries a substantial risk of rupture, thrombosis with subsequently systemic embolization, and compression of the surrounding structures. Case summary We describe a case of a transcatheter repair of a more complex and uncommon pseudoaneurysm following aortic valve replacement in a patient with a history of arterial switch repair for transposition of the great arteries. The pseudoaneurysm originated from the aortic wall and connected to the left ventricular outflow tract (LVOT). The connection to LVOT was closed with a duct occluder, the neck to the aortic wall with an atrial septal defect occluder. After 1 month, the complete pseudoaneurysm was successfully thrombosed. Discussion Percutaneous closure of a complex pseudoaneurysm after arterial switch repair is feasible and safe. However, lifelong follow-up is needed to determine the late results after transcatheter interventions.
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Affiliation(s)
- Lisa Carmans
- Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Els Troost
- Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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37
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Infected aortic pseudoaneurysm repair using autologous common femoral artery patch and fascia. Gen Thorac Cardiovasc Surg 2020; 68:1487-1491. [PMID: 32040819 DOI: 10.1007/s11748-020-01310-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
Using autologous common femoral artery and external oblique muscle fascia is a simple and reliable option for repairing infected aortic pseudoaneurysms. Reoperation of infected pseudoaneurysms is challenging and requires secure aortic repair with complete infection eradication. Here, we report two cases of infected pseudoaneurysms in the ascending aorta cannulation site after cardiac surgeries. Common femoral arteries and fascia were harvested in the same lesion as repair materials. The aortic pseudoaneurysms were repaired under deep hypothermic circulatory arrest. Femoral arterial patches were reinforced with circumferential aponeurosis strips. There was no infection recurrence or repair site dilatation in the long-term follow up of both patients.
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38
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Roberts CS, Salam YM, Moore AJ, Roberts WC. Pseudoaneurysm of the Ascending Aorta at the Cannulation Site Diagnosed More Than Four Decades After Repair of Ventricular Septal Defect. Am J Cardiol 2019; 124:1962-1965. [PMID: 31699357 DOI: 10.1016/j.amjcard.2019.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 09/10/2019] [Indexed: 11/18/2022]
Abstract
Described herein is a 69-year-old woman who developed a large saccular aortic aneurysm at a previous cannulation site for repair of a ventricular septal defect at age 25 years. The aneurysm was resected and proved histologically to be a false one. The long interval between operations (44 years) exceeds those reported previously.
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Affiliation(s)
- Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Yusuf M Salam
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Alastair J Moore
- Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Radiology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - William C Roberts
- Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
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39
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Meijs TA, Krings GJ, Molenschot MMC, Voskuil M. Endovascular coil embolization of a complex aortic arch pseudoaneurysm following arch stenting. Catheter Cardiovasc Interv 2019; 94:1006-1009. [PMID: 31389117 PMCID: PMC6916550 DOI: 10.1002/ccd.28424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/27/2019] [Accepted: 07/25/2019] [Indexed: 01/16/2023]
Abstract
Pseudoaneurysm formation is a life-threatening complication of thoracic aortic stenting due to the high risk of rupture. When located in the aortic arch, anatomic features may pose difficulties in choosing the optimal treatment strategy. Here, we describe the first poststenting aortic arch pseudoaneurysm treated by endovascular coil embolization. This approach, which we performed in a multidisciplinary setting, may be a feasible alternative in patients not considered suitable for open repair or stent-grafting. As an acute pseudoaneurysm may develop and rapidly expand during the first days after aortic stenting, early follow-up imaging is preferable.
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Affiliation(s)
- Timion A Meijs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gregor J Krings
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Mirella M C Molenschot
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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40
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De Gaspari M, Basso C, Perazzolo Marra M, Thiene G, Rizzo S. Multiple mycotic aneurysms of the aortic root after aortic valve replacement. Cardiovasc Pathol 2019; 44:107152. [PMID: 31760245 DOI: 10.1016/j.carpath.2019.107152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/09/2019] [Accepted: 09/02/2019] [Indexed: 10/25/2022] Open
Abstract
A 74-year-old woman with severe aortic valve stenosis underwent aortic valve replacement with a pericardial bioprosthesis. Histological analysis of the excised valve showed dystrophic calcification associated with signs of healed infective endocarditis. Two months later, the patient died due to congestive heart failure. Autopsy revealed a bowel infarction and the presence of multiple mycotic aneurysms of the aortic root with mural thrombosis, which were unnoticed during the patient hospital stay and surgical window.
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Affiliation(s)
- Monica De Gaspari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy.
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Stefania Rizzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
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41
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Numata S, Kanda K, Yaku H. Aortic Arch Pseudoaneurysm Associated With Chronic Trauma by Resected Edge of the Left Clavicle. JACC Case Rep 2019; 1:417-418. [PMID: 34316841 PMCID: PMC8288828 DOI: 10.1016/j.jaccas.2019.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Abstract
A 66-year-old man, who had a history of left lung and clavicle resection, was referred to us for aortic arch pseudoaneurysm. Resected edge of the left clavicle was attached to the anterior surface of the aortic arch. Patch repair of the pseudoaneurysm using hypothermic circulatory arrest was performed successfully. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Kanda
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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42
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Parhar D, Klass D, Legiehn G, Chung J, Cheung A, Janusz M. Transapical Coil Embolization of a Postsurgical Ascending Thoracic Aortic Pseudoaneurysm. Cardiovasc Intervent Radiol 2019; 42:1500-1504. [PMID: 31338553 DOI: 10.1007/s00270-019-02291-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Abstract
Ascending aortic pseudoaneurysms are a rare but potentially life-threatening complication of aortic root or cardiac surgery. Surgical repair is established as first-line treatment; however, patient comorbidities, technical considerations, and anatomic limitations often preclude patients from repeat surgery, thus necessitating alternative approaches. Here, we present a case of coil embolization of an ascending aortic pseudoaneurysm via a transapical approach in a particularly complex scenario where percutaneous and peripheral access was technically unfeasible.
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Affiliation(s)
- Dennis Parhar
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Darren Klass
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Gerald Legiehn
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John Chung
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Anson Cheung
- Department of Cardiovascular Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Michael Janusz
- Department of Cardiovascular Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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43
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Besho JM, Tanaka A, Safi HJ, Estrera AL. Pseudoaneurysm of the Thoracoabdominal Aortic Graft Due to Intercostal Nerve Block. Ann Thorac Surg 2019; 108:e189-e191. [PMID: 30872096 DOI: 10.1016/j.athoracsur.2019.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 11/26/2022]
Abstract
Pseudoaneurysms of the descending aorta after open graft replacement usually occur in patients with connective tissue disorders and form at anastomotic or cannulation sites. We present a case of an iatrogenic pseudoaneurysm in the descending thoracic aortic graft body caused by intercostal nerve block. The patient had undergone repair for thoracoabdominal aortic aneurysm 4 years prior and underwent a series of intercostal nerve blocks after experiencing persistent postthoracotomy pain. A pseudoaneurysm in the descending thoracic graft, contiguous with the chest wall, was encountered. He underwent successful pseudoaneurysm resection with redo graft replacement, resulting in significant pain relief.
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Affiliation(s)
- Joseph M Besho
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Akiko Tanaka
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Hazim J Safi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
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44
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Drake DH. Bicuspid Aortic Valve Disease, False Aneurysms, and the Role of Echocardiography: Surgical Context and Perspective. J Cardiothorac Vasc Anesth 2019; 33:1471-1472. [PMID: 30616895 DOI: 10.1053/j.jvca.2018.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel H Drake
- Department of Surgery, Munson Medical Center, Traverse City, MI
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45
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Abstract
Spectral Doppler is a part of the comprehensive echocardiographic imaging of the blood flow characteristics. Both pulsed-wave (PWD) and continuous-wave Doppler (CWD) provide valuable information about the blood flow speed and direction pattern. Evaluation of blood flow characteristics is crucially important in patients who present with thoracic aortic false aneurysm (TAFA). In the case presented, spectral Doppler interrogation, using both PWD and CWD, helped with establishing accurate mechanism for TAFA and guided surgical management.
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Affiliation(s)
- Andrej Alfirevic
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH.
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46
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Intolerably high risk in ascending aortic surgery. J Thorac Cardiovasc Surg 2018; 156:e187-e188. [PMID: 30098808 DOI: 10.1016/j.jtcvs.2018.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/23/2022]
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47
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Manetta F, Newman J, Mattia A. Indications for Thoracic EndoVascular Aortic Repair (TEVAR): A Brief Review. Int J Angiol 2018; 27:177-184. [PMID: 30410287 DOI: 10.1055/s-0038-1666972] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The utility of Thoracic EndoVascular Aortic Repair (TEVAR) continues to progress at a very rapid rate. Initially implemented for the treatment of thoracic aortic aneurysms, TEVAR has evolved to treat a variety of aortic pathologies and reduce overall morbidity and mortality rates compared with traditional open surgical repair. Given the rapidly evolving nature of endovascular thoracic intervention, we hereby briefly review the current literature on the evolving applications of TEVAR. TEVAR continues to rapidly evolve and is being applied to a growing number of aortic pathologies. Given the perioperative, short- and mid-term morbidity and mortality rates, TEVAR is quickly surpassing traditional open surgical intervention as the ideal procedure for patients undergoing intervention of the descending thoracic aorta and applicability to ascending and arch pathologies is being explored. However, as more data becomes available TEVAR may be associated with higher rates of reoperative requirements. Data remains limited on the long-term efficacy of the intervention and should continue to be investigated.
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Affiliation(s)
- Frank Manetta
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, Bay Shore, New York.,Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, New York
| | - Joshua Newman
- Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, New York
| | - Allan Mattia
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, Bay Shore, New York.,Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, New York
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48
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Ruge H, Herold U, Lange R. Stent-graft treatment of an ascending aortic false aneurysm after surgical aortic valve replacement. J Thorac Cardiovasc Surg 2018; 156:e183-e185. [PMID: 29958659 DOI: 10.1016/j.jtcvs.2018.05.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany.
| | - Ulf Herold
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany
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49
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Liu RH, Fraser CD, Zhou X, Cameron DE, Vricella LA, Hibino N. Pseudoaneurysm formation after valve sparing root replacement in children with Loeys-Dietz syndrome. J Card Surg 2018; 33:339-343. [DOI: 10.1111/jocs.13709] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rui H. Liu
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Charles D. Fraser
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Xun Zhou
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Duke E. Cameron
- Division of Cardiac Surgery; The Massachusetts General Hospital; Boston Massachusetts
| | - Luca A. Vricella
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Narutoshi Hibino
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore Maryland
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50
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Surgical management of ascending aortic pseudoaneurysm in a 2-year-old boy: a case report. J Med Case Rep 2018; 12:98. [PMID: 29661244 PMCID: PMC5902866 DOI: 10.1186/s13256-018-1625-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aortic pseudoaneurysms are rare but life-threatening complications usually seen after cardiac surgery. The causes could be multifactorial such as infection or trauma. CASE PRESENTATION We report the surgical management of a postoperative pseudoaneurysm of the ascending aorta caused by methicillin-resistant Staphylococcus aureus in a 2-year-old Middle Eastern boy who had undergone ventricular septal defect closure, subaortic membrane resection, and pulmonary artery de-banding. He was immediately operated on for resection of the aneurysm. A computed tomography scan at 2 months following surgery showed no aneurysm. Antibiotics were continued for 6 weeks and our patient was discharged with negative blood cultures. CONCLUSION Early diagnosis and appropriate treatment of such rare complication can be lifesaving.
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