Srpski arhiv za celokupno lekarstvo 2012 Volume 140, Issue 11-12, Pages: 765-767
https://doi.org/10.2298/SARH1212765B
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Ascending aorta false aneurysm as a late complication of aortic valve surgery
Bilbija Ilija (Klinika za kardiohirurgiju, Klinički centar Srbije, Beograd)
Velinović Miloš (Klinika za kardiohirurgiju, Klinički centar Srbije, Beograd)
Vraneš Mile (Klinika za kardiohirurgiju, Klinički centar Srbije, Beograd)
Đukić Petar (Klinika za kardiohirurgiju, Klinički centar Srbije, Beograd)
Savić Dragutin (Klinika za kardiohirurgiju, Klinički centar Srbije, Beograd)
Putnik Svetozar (Klinika za kardiohirurgiju, Klinički centar Srbije, Beograd)
Introduction. False aneurysms of the ascending aorta represent a rare but
potentially fatal complication of cardiac surgical procedures. Predisposing
factors are aortic dissection, infection, connective tissue disorders,
chronic hypertension, aortic calcifications and aortotomy dehiscence. At the
beginning they are usually asymptomatic, but later various symptoms arise as
a consequence of vital structures compression. Potential risk of rupture
rises with time and pseudoaneurysm enlargement. From surgical point of view
treatment of such cases represents a unique challenge because of the great
danger of inadvertent opening of the aneurysm during resternotomy. Case
Outline. A 58-year-old female patient underwent aortic valve replacement due
to severe aortic stenosis in 2004. Operation and postoperative recovery were
uneventful. Three years later she started complaining about chest pain. On
chest X-ray there was upper mediastinal widening. CT scan showed a
pseudoaneurysm of the ascending aorta located in front of the right atrium
and right ventricle, which was subsequently verified by angiography. During
redo operation the pseudoaneurysm was successfully resected and aorta closed
with separate ethybond sutures with pledgets. Conclusion. Postoperative
pseudoaneurysms of the ascending aorta mostly arise from the suture lines.
The most useful diagnostic procedures are contrast CT scan, echocardiography,
angiography and MRI. Surgical intervention is absolutely indicated. The
institution of cardiopulmonary bypass by alternative ways before chest
opening is strongly recommended.
Keywords: pseudoaneurysm, false aneurysm, ascending aorta, aortic valve, resternotomy