Pseudoaneurysms of the ascending aorta following coronary artery bypass surgery

Endovascular repair of ascending aorta pseudoaneurysm post-extracorporeal membrane oxygenation cannulation during pulmonary transplant

We demonstrated an endovascular technique excluding an ascending aorta pseudoaneurysm using an aortic extension. A 32-year-old woman, 3 years after lung transplantation with extracorporeal membrane oxygenation presented with an ascending aortic pseudoaneurysm. Vascular surgery was consulted after open repair was deemed high risk. An aortic extension stent graft was placed in a hybrid operating room with the aid of intraoperative transesophageal echocardiography. Ascending aorta pseudoaneurysms are complex and life-threatening complications. Traditional repair involves high surgical and anesthetic risks whereas endovascular treatment is technically feasible.

Large Ascending Aortic Pseudoaneurysm with Focal Dissection after Coronary Artery Bypass Surgery

Background  There are many known complications that occur after surgical revascularization for patients with significant left main coronary artery disease. Case Description  This case report highlights the preoperative workup, surgical approach, and postoperative management of a patient who presents with an aortic pseudoaneurysm and dissection 2 years after the index CABG. Conclusion  The development of an aortic pseudoaneurysm in combination with an ascending aortic dissection after prior coronary artery bypass grafting (CABG) is a rare compilation of complications that has scarcely been reported in the literature.

Cardiac solution for a vascular scenario!

BACKGROUND

Ascending aortic pseudoaneurysms (AAPs) constitute a rare, albeit potentially dangerous, condition that occurs in up to 13% of patients after cardiac or aortic surgeries. For patients with a history of cardiac surgery, repeat thoracotomy poses additive risks. The high morbidity and mortality rates associated with the surgical management of AAPs have led to the development of transcatheter approaches.

CASE REPORT

We report a case of AAP percutaneous closure at the site of aortic cannulation with an ASO device in a post-CABG 65-year-old man, who refused surgery.

CONCLUSION

The use of the Amplatzer Atrial Septal Defect Occluder (ASO) device represents an acceptable alternative to surgery in treatment of Ascending aortic pseudoaneurysms.

The Dilemma in the Management of Thromboembolic Disease in the Setting of Concomitant Aortic Pseudoaneurysm

Ascending aortic pseudoaneurysm (AAP) is a rare and serious complication of cardiothoracic surgeries or blunt chest trauma. We present a patient with paroxysmal atrial fibrillation, acute right pontine stroke, and acute pulmonary embolism (PE) with an incidental AAP that precluded the use of anticoagulation and surgery. The case findings substantiate the need for a CT-based assessment of aortic pathology after coronary artery bypass grafting (CABG) in the asymptomatic patient to determine the most appropriate treatment modalities. However, the high cost of CT imaging and the potential radiation exposure challenge its routine use in high-risk patients.

Mycotic Pseudoaneurysm Formation at the Cannulation Site in the Ascending Aorta

The formation of mycotic pseudoaneurysms in the ascending aorta is a rare but sometimes fatal complication after open-heart surgery, requiring cardiopulmonary bypass (CPB). There has been little cited about this rare complication. We present a case of a 51-year-old man who developed a mycotic pseudoaneurysm in the ascending aorta at a previous aortic cannulation site nine years after coronary artery bypass surgery. The patient presented to the emergency department with two weeks of worsening substernal chest pain and was found to have pseudoaneurysm in the anterior wall of the ascending aorta on chest computed tomography angiography (CTA) during his chest pain workup. The patient's blood cultures grew methicillin-susceptible Staphylococcus aureus (MSSA). During the hospital course, the patient's respiratory status worsened, and repeat CTA revealed enlargement of the pseudoaneurysm arising from the anterior proximal arch of the aorta. Chest X-ray obtained because of hypoxia demonstrated widening of the upper mediastinum, which appeared increased compared with the previous exam. Because of concern for rupture of an aneurysm, the patient was taken to the operating room for redo sternotomy and repair of the pseudoaneurysm with femoral artery cannulation for cardiopulmonary bypass. The patient completed eight weeks of IV nafcillin, and rifampin was added to decrease biofilm formation.

3D model-guided transcatheter closure of ascending aorta pseudoaneurysm with the novel Amplatzer Trevisio intravascular delivery system

Ascending aorta pseudoaneurysm (AAP) is a rare but life-threatening complication of atherosclerosis, endocarditis, chest trauma, transcatheter or cardio-thoracic procedures. Since surgical repair is burdened by high morbidity and mortality, percutaneous closure is nowadays considered a valuable cost-effective therapeutic alternative. Due to unpredictability and complexity of local anatomy, no standardized technique and device are advised. In this setting, 3D printing technology could significantly help in planning trans-catheter approach. This article reports on a 3D printed model-guided percutaneous closure of a huge AAP using an Amplatzer Septal Occluder (Abbott, Plymouth MN) implanted by the recently commercialized Amplatzer Trevisio Intravascular Delivery System.

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.

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.

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.

Percutaneous thoracic endovascular aortic repair for ascending aortic pseudoaneurysm after prosthetic aortic valve repair

Ascending aortic pseudoaneurysms are an uncommon and challenging surgical problem that requires intervention to avoid rupture and hemorrhage. Preceding cardiac procedures often compound the high rate of morbidity and mortality associated with open repair. A case is described of an iatrogenic pseudoaneurysm in a patient with a recently placed prosthetic aortic valve and a clinical course precluding repeat open operative procedure. An endovascular approach was used, with placement of a thoracic aorta endograft with temporary cardiac pacing and a double-curved Lunderquist wire to avoid instrumenting the prosthetic aortic valve. At 9 months of follow-up, the patient returned to his baseline activity status, and at 24 months, had no symptoms or signs of infection, and a computed tomography angiogram demonstrated pseudoaneurysm exclusion with no graft migration.

"To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms

Medical ultrasound imaging with Doppler plays an essential role in the diagnosis of vascular disease. This study intended to review the clinical use of “to-and-fro” waveform at duplex Doppler ultrasonography (DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of “to-and-fro” waveform at DDU also. After receiving institutional review board approval, an inclusive literature review was carried out in order to review the scientific foundation of “to-and-fro” waveform at DDU and its clinical use in the diagnosis of pseudoaneurysms in various arterial vessels. Articles published in the English language between 2000 and 2013 were evaluated in this review study. Pseudoaneurysms in arterial vessels of the upper and lower extremities, abdominal aorta, carotid and vertebral arteries characterized by an extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and “to-and-fro” flow pattern on color Doppler ultrasonography. In these arterial vessels, Duplex ultrasonography can demonstrate the degree of clotting, pseudoaneurysm communication, the blood flow patterns and velocities. Spectral Doppler applied to pseudoaneurysms lumen revealed systolic and diastolic turbulent blood flow with traditional “to-and-fro” waveform in the communicating channel. Accurate diagnosis of pseudoaneurysm by spectral Doppler is based on the documentation of the “to-and-fro” waveform. The size of pseudoaneurysm determines the appropriate treatment approach as surgical or conservative.

Aspergillus thromboembolism from a mycotic ascending aortic pseudoaneurysm

This case report describes an immune-competent patient with acute upper extremity ischemia caused by thromboembolism from an Aspergillus-infected ascending aortic pseudoaneurysm. Efforts to identify the source of an acute arterial thromboembolic occlusion should be made, and a high index of suspicion for mycotic infection should be maintained in patients with an atypical presentation, such as fevers of unknown origin. Additional measures, such as pathologic examination of thromboembolic debris, blood cultures, and positron emission tomography, should be performed to identify the etiology in these unexplained situations.

MDCT evaluation of postoperative aortic root pseudoaneurysms: imaging pearls and pitfalls

OBJECTIVE

Aortic root pseudoaneurysm is a rare but potentially lethal complication after cardiac surgery. The objective of this article is to review the CT appearance of postoperative aortic root pseudoaneurysms, with emphasis on imaging pearls and pitfalls.

CONCLUSION

The most common location for postoperative aortic root pseudoaneurysm is the graft anastomosis site. MDCT with ECG gating and multiplanar and 3D reconstruction can provide critical information for preoperative planning.

Surgical management of a ruptured pseudoaneurysm late after total arch replacement with omentoplasty

Aortic pseudoaneurysm is a rare, life-threatening complication after cardiac or aortic surgery. In this article, we report reoperation on an 86-year-old man undergoing total arch replacement and omentoplasty for an infectious aortic aneurysm, 5 years previously. He was transferred to our hospital and fell into shock. Prompt drainage of the right-side pleural cavity manifested 2000 ml of blood. Computed tomography revealed contrast extravasation into a pseudoaneurysm, which arose from the proximal anastomotic site of the ascending aorta. The patient underwent emergent surgery that included an extremely careful dissection of the omentum and pericardial adherences, through the re-sternotomy. The patient recovered without neurological sequelae.

Mycotic ascending aortic pseudoaneurysm at aortic cannulation site

Mycotic aneurysm of the aorta is a rare but highly fatal complication of coronary bypass surgery. A 49-year-old man developed mycotic pseudoaneurysm in the ascending aorta after coronary bypass in another hospital. Computed tomography showed the pseudoaneurysm originated from the previous aortic cannulation site. The defect was successfully repaired with pericardial-pledgeted sutures.

Hybrid Treatment of Ascending Aortic Pseudoaneurysm: Endovascular Stent-graft Placement and Extraanatomic Reconstruction without Sternotomy

Conventional surgical repair of ascending aortic pseudoaneurysms following prior cardiac operations is performed with a high operative mortality. We report a 67 year old female patient with an ascending aortic pseudoaneurysm detected 3 years after coronary bypass surgery. The patient was treated with ascending aortic endovascular stent graft placement and extraanatomic reconstruction of supraaortic branches without using sternotomy.