Pseudoaneurysm of the ascending aorta complicating cardiac surgery: role of echocardiography in the diagnosis

Stroke in patient with an intervalvular fibrosa pseudoaneurysm and aortic pseudoaneurysm

We describe a case of an intervalvular fibrosa pseudoaneurysm associated with a cerebrovascular accident. This case in unusual as the likely source of embolic stroke was thrombus from within the pseudoaneurysm. Transesophageal echocardiography also demonstrated a communication between the intervalvular fibrosa and the proximal aorta.

Transesophageal echocardiographic diagnosis of a mycotic ascending aortic pseudoaneurysm as a source of embolism

Pseudoaneurysm of the ascending aorta may develop after aortic injury from trauma or surgery. We report a case of dehiscence of an aortic graft leading to ascending aortic pseudoaneurysm that was diagnosed by transesophageal echocardiography. In addition, the transesophageal echocardiogram identified the pseudoaneurysm as the likely cause of a saddle embolus to the iliac bifurcation of the aorta. This case is also unique in that the patient's pseudoaneurysm was infected with fungus.

Post-traumatic pseudoaneurysm of the ascending aorta--an incidental finding two decades later

Traumatic rupture of the aorta following blunt trauma is a well described entity. Rupture of the ascending aorta is frequently associated with concomitant cardiac damage and immediate death with few long-term survivors described in the literature. A case of traumatic pseudoaneurysm of the ascending aorta discovered two decades after the initial injury is reported.

Echocardiography in the diagnosis of thoracic aortic pathology

Transthoracic two-dimensional and Doppler echocardiography has been well established as a useful technique for evaluating many pathologic processes affecting the thoracic aorta. However, the distance of the aortic arch and descending thoracic aorta from the chest wall and the interposition of highly attenuating lung and highly reflective mediastinal structures between the transducer and the aorta present unavoidable limitations. Transesophageal echocardiography is a relatively new technology that overcomes many of the inherent limitations with transthoracic imaging. Complete echocardiographic evaluation of the entire thoracic aorta can now be achieved in nearly all patients. This article will review the continually expanding role of echocardiography in the evaluation of thoracic aortic pathology, including the dramatic impact of transesophageal imaging on the diagnosis of life-threatening disorders such as aortic dissection.

Diagnosis of aortic pseudoaneurysm by echocardiography

The diagnosis of pseudoaneurysm of the ascending aorta is of paramount importance because of its propensity to rupture. As the frequency of surgical procedures involving the aortic root and valve increases, an increase in the incidence of aortic pseudoaneurysm may be anticipated. We recently studied a patient who developed pseudoaneurysm of the ascending aorta following repair of a Type I aortic dissection, utilizing a composite graft. Two-dimensional echocardiography with color flow and pulsed Doppler imaging showed a large perigraft cavity communicating with the aorta. Echocardiography provides a safe noninvasive diagnostic tool for the evaluation of the aorta postoperatively and for screening for pseudoaneurysm formation in the follow-up period.