Surgical treatment of pseudoaneurysm of the thoracic aorta

Surgical Strategies in Reoperation of the Proximal Aorta and Arch for Patients with Previous Frozen Elephant Trunk

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.

Comprehensive multi-modality treatment of thoracic aorta pseudoaneurysms: a single-center experience

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.

False aneurysms of the thoracic aorta: anastomosis investigation using the inflation-extension test

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.

Aortic Pseudoaneurysm following Ventricular Septal Defect Closure in a Pediatric Patient: A Case Report and Literature Review

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.

Hypothermic Circulatory Arrest in Median Sternotomy Hemorrhage During Redo Aortic Surgery

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.

Transcatheter closure of postsurgical aortic pseudoaneurysms guided by three-dimensional image reconstruction: a single-centre experience

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.

Granulomatous inflammation mimicking a hematoma around the replaced ascending aorta in magnetic resonance imaging: a case report

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.

Total Endovascular Treatment of Ascending Aorta Pseudoaneurysm After Bentall Procedure

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.).

Ascending Aortic Pseudoaneurysm Following Aortic Valve Replacement: A Case Report and Literature Review

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.

Three-dimensional printing in integrated multi-modality imaging approach for management of prosthetic valves infective endocarditis

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.

Large aortic pseudoaneurysm after Bentall procedure in a patient with Marfan's syndrome

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.

Pseudoaneurysm with a fistula to the right ventricle late after surgical repair of type A aortic dissection in a patient with systemic lupus erythematosus

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.

Aortic Pseudoaneurysm After Type A Aortic Dissection: Results of Conservative Management

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.

Percutaneous closure of a post-surgical ascending aortic pseudoaneurysm with an amplatzer septal occluder device and steerable guiding sheath

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.

Emergent endovascular repair of a ruptured ascending aorta pseudoaneurysm with thoracic aortic stent graft

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.

Transradial Closure of a Large Ascending Aortic Pseudoaneurysm With a Duct Occluder II - A Case Report

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.

Surgical Treatment of Pseudoaneurysm of the Ascending Aorta in a Patient with Sepsis

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.

Hybrid repair of ascending aortic pseudoaneurysm

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.

Recurrent ascending aortic pseudoaneurysms: rare but a feared complication

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.

Ruptured pseudoaneurysm of the thoracic aorta mimicking lung cancer: A case report

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.

Postcardiosurgical pseudoaneurysm

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.

Surgical management of a pulsatile chest wall mass secondary to an ascending aortic aneurysm in a patient with bovine arch

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.

Ascending aorta pseudoaneurysm simulating mediastinal lymphoma in computed tomography, a possible diagnostic error: a case report

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.

Imaging evaluation using computed tomography after ascending aortic graft repair

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.

Management of Aortic Pseudoaneurysms: Evolving Concepts and Controversies

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.

Long-term follow-up after Bentall operation using a stentless Shelhigh NR-2000 bio-conduit

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.

Percutaneous closure of an uncommon aortic pseudoaneurysm after arterial switch repair: a case report

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.

Infected aortic pseudoaneurysm repair using autologous common femoral artery patch and fascia

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.

Pseudoaneurysm of the Ascending Aorta at the Cannulation Site Diagnosed More Than Four Decades After Repair of Ventricular Septal Defect

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.

Endovascular coil embolization of a complex aortic arch pseudoaneurysm following arch stenting

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.

Multiple mycotic aneurysms of the aortic root after aortic valve replacement

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.

Aortic Arch Pseudoaneurysm Associated With Chronic Trauma by Resected Edge of the Left Clavicle

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.)

Transapical Coil Embolization of a Postsurgical Ascending Thoracic Aortic Pseudoaneurysm

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.

Pseudoaneurysm of the Thoracoabdominal Aortic Graft Due to Intercostal Nerve Block

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.

Back to the Future-Importance of Spectral Doppler

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.

Indications for Thoracic EndoVascular Aortic Repair (TEVAR): A Brief Review

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.

Surgical management of ascending aortic pseudoaneurysm in a 2-year-old boy: a case report

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.