Abstract
False aneurysm occurring after replacement of ascending aorta by a vascular prosthesis is a rare, but life-threatening complication. In spite of advances in endovascular techniques, surgery remains the treatment of choice in the majority of cases. We report the case of a huge pseudoaneurysm caused by late dehiscence of the right coronary ostium-aortic tubular graft anastomosis, occurred 30 years after replacement of aortic valve and ascending aorta by classical Bentall operation. A fistula originating from the aneurysmal sac extended across the sternum into the thoracic subcutaneous soft tissues and gave rise to a pulsatile mass well appreciable on the anterior chest wall. The surgical treatment, consisting of partial resection of the aortic tubular graft and sternal reconstruction was effective and uneventful.
Highlights
Reoperations for large false aneurysms of the ascending aorta secondary to previous surgical interventions represent a surgical challenge [1] [2]
Surgery is mandatory in most cases and consists of false aneurysm exclusion and excision along with reconstruction of the aortic vascular prosthesis
Additional risk factors are the size of the false aneurysm, obesity, urgent surgical intervention, sepsis, pre-existing dilation of the ascending aorta and arterial hypertension
Summary
Reoperations for large false aneurysms of the ascending aorta secondary to previous surgical interventions represent a surgical challenge [1] [2]. They are located just below the sternum, with higher risk of a fatal, uncontrollable hemorrhage often associated to massive cerebral air embolism, during repeat sternotomy. Surgery is mandatory in most cases and consists of false aneurysm exclusion and excision along with reconstruction of the aortic vascular prosthesis. Due to a complete dehiscence of the right coronary artery ostium-vascular prosthesis anastomosis, occurred on uncertain date, a huge retrosternal false aneurysm had developed, along with a fistula expanded into the subcutaneous tissue of the left anterior upper chest wall.
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