Abstract
A left ventricular (LV) pseudoaneurysm is one of the complications of acute myocardial infarction. It is also reported after chest trauma, cardiac surgery, and endocarditis. We report a rare case of an LV pseudoaneurysm induced by an LV venting catheter through the right superior pulmonary vein during thoracic aortic surgery. A 77-year-old man was referred for surgical repair of a distal aortic arch aneurysm. He underwent total aortic arch reconstruction with the frozen elephant trunk technique. The early postoperative period was uneventful. Postoperative contrast computed tomography and transthoracic echocardiography (TTE) revealed a pseudoaneurysm with a narrow neck at the apex of the LV that had sub-clinically progressed. Because of the risk of spontaneous rupture, an urgent aneurysmectomy was performed via a repeat sternotomy. Under cardioplegic arrest, the pseudoaneurysm was opened and the small orifice, which communicated with the LV, was confirmed. No myocardial ischemic changes were observed around the orifice. The pseudoaneurysm was thought to be induced by endocardial laceration by the tip of the venting catheter. The pseudoaneurysm was closed by linear repair reinforced with felt strips. The patient recovered well and was discharged 18 days after the second surgery. TTE showed no recurrence of LV aneurysm at the last follow-up.
Highlights
We report a rare case of an left ventricular (LV) pseudoaneurysm induced by an LV venting catheter through the right superior pulmonary vein during thoracic aortic surgery
There are some reports of LV pseudoaneurysm resulting from apical venting [4] [5] [6] [7], but LV pseudoaneurysm due to an LV venting catheter inserted from the right superior pulmonary vein has rarely been reported
We present a rare case of LV pseudoaneurysm induced by an LV venting catheter via the right superior pulmonary vein during thoracic aortic surgery
Summary
It is reported after chest trauma, cardiac surgery, and endocarditis [1] [2]. We present a rare case of LV pseudoaneurysm induced by an LV venting catheter via the right superior pulmonary vein during thoracic aortic surgery. A 77 year-old man was referred for surgical repair of a distal aortic arch aneurysm. Routine contrast CT, performed 15 days post-surgery, detected a pseudoaneurysm with a narrow neck at the apex of the LV (Figure 2). TTE, performed 16 days post-surgery, confirmed the presence of the pseudoaneurysm with a diameter of 35 × 26 mm at the apex of the LV, communicating with the LV through an orifice 8 mm in diameter (Figure 3).
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