Aortic redissection after glue repair: a rare echocardiographic finding.

Abstract

A 66-year-old male patient underwent supracoronary ascending aortic grafting and resuspension of the incompetent aortic valve because of a type A aortic dissection. Three months later, he presented with ongoing low-grade fever and sternal wound discharge. Wound and blood cultures were positive for methicillinresistant Staphylococcus aureus. Sinography was consistent with mediastinitis and infection of the vascular prosthesis. Magnetic resonance angiography and computed tomography angiography showed redissection at the distal anastomotic site extending down to the abdominal aorta and both of the common iliac arteries. Transesophageal echocardiography (TEE) findings were equivocal (Fig. 1). We considered the possibility of vegetation on the vascular graft. After a 6-week-long unsuccessful treatment with intravenous antibiotics, the patient was referred for redo surgery. Surgical findings included: (1) dehiscence of the distal anastomotic site and (2) a piece of surgical adhesive (BioGlue , CryoLife, Inc., Kennesaw, GA), which was used during the first operation, found protruding into the false aortic lumen (Fig. 2). This piece of surgical glue produced the rare echocardiographic picture seen on TEE.