Aortic Pseudoaneurysm Research Articles

Iatrogenic pseudoaneurysm of patent ductus arteriosus following prior PDA closure in a teenager

Iatrogenic pseudoaneurysm after transcatheter closure of patent ductus arteriosus (PDA) is a rare complication and potentially fatal, with a few reported cases in the literature. We reported a 12-year-old child's case of PDA treated with a 12/10-mm Amplatzer duct occluder two years ago, developed with progressive dyspnea, cough, and progressive limitation of physical activity in the last two weeks. The chest computed tomography (CT) scan showed a saccular pseudoaneurysm measuring about 7.4 × 6 × 4 cm in the proximal part of descending aorta. The patient underwent open surgical exploration, the aortic pseudoaneurysm was removed, and an interposition graft was performed. The postoperative outcome was uneventful and without complications. In conclusion, an intragenic pseudoaneurysm following PDA repair is a rare phenomenon. A CT scan provides an excellent evaluation to make a diagnosis and treatment plan. In a resource-limited setting, open surgical repair is still the best option, as performed in our case.

Cardiac device to plug an aorto-bronchial fistula

BackgroundPost-coarctoplasty aortic pseudoaneurysms constitute a lethal problem occurring in up to 38% of patients with a history of aortic coarctation surgical repair. Such pseudoaneurysms are prone to rupture if managed conservatively and high mortality and morbidity if treated with open surgery. Therefore, the endovascular approach has been proposed for their management.Case reportWe describe a patient with a post-coarctoplasty aortic pseudoaneurysm complicated by an aortobronchial fistula. The case was treated via the endovascular approach (thoracic endovascular aortic repair and endovascular coarctoplasty) with an atrial septal defect occluder device.ConclusionsEndovascular repair is a feasible, safe, and promising treatment for thoracic aortic pseudoaneurysms secondary to coarctation repair.

Aortic Fistula Plug: A Moving Target

A middle aged male with history of Fallot type Double outlet right ventricle and coarctation of aorta who underwent multiple surgeries since childhood. With RV to pulmonary artery conduit and end to end coarctation repair initially, followed by aortic valve, pulmonary valve and RV-PA conduit replacements later. He subsequently developed significant flow through a fistula between a previously coiled aortic pseudoaneurysm and LVOT. This was percutaneously closed with a vascular plug and additionally a PFO, detected, was closed with a device. Patient returned to the clinic with decompensated heart failure. Updated imaging demonstrated that the plug had migrated and together with the coil, which was impinging on the AVR, resulting in severe supra-valvar AS and continuous significant persistent residual flow across the Aorta- LVOT fistula via false aneurysm. Our case highlights the importance of using multimodality imaging for complex congenital heart diseases. In view of high surgical risks associated with previous multiple sternotomies and patient’s preference, percutaneous approaches were adopted initially: however, it was unfortunate to see the migration of vascular plug. After successful deployment of AVP, migration or recanalization is rare, but should not be completely discounted.

Aorta's pseudoaneurysm fistulized to pulmonary artery

Aorta's pseudoaneurysm fistulized to pulmonary artery

Large aortic pseudoaneurysm after fusion surgery for hyperextension-type lumbar fracture in diffuse idiopathic skeletal hyperostosis: illustrative case.

This study aimed to report an aortic pseudoaneurysm, a rare but lethal complication, after a spinal fracture in ankylosing spine. An 83-year-old obese woman presented with dementia and was nonambulatory after a fall. She was transported to the hospital, and imaging showed a hyperextension-type L1 fracture with diffuse idiopathic skeletal hyperostosis (DISH). After posterior fusion surgery using percutaneous pedicle screws, screw loosening was detected 10 days postoperatively. Fracture dislocation was reduced by changing to transdiscal screws and rodding while in the lateral position. However, the anterior opening persisted. Enhanced computed tomography performed at 6 weeks postoperatively showed a large aortic pseudoaneurysm extending into the vertebral fracture site without screw loosening. Neither endovascular aortic repair nor open surgery was applicable. The patient was transferred to a sanatorium and died of pneumonia 5 months postoperatively without aortic aneurysm rupture. An aortic pseudoaneurysm can occur in hyperextension-type spinal fractures in DISH, even after fusion surgery, when the edge of the fracture is in contact with the aortic wall. The anterior opening dislocation should be reduced as much as possible.

Evaluating the risk of spinal cord ischemia in zone 2 frozen elephant trunk replacement

BackgroundThe appropriate stent length in frozen elephant trunk replacements (FET) remains debated relative to the risk for paraplegia. However, landing the distal end of the stent beyond the curve of the arch facilitates distal reintervention, which is commonly beyond the 10 cm stent coverage when deployed proximal to the left subclavian artery. The aim of this study was to evaluate outcomes following the use of 15 cm stent grafts in zone 2 (z2, distal to the left common carotid). MethodsUsing our single institution-maintained database, 103 zone 2 FET performed from 2016 to 2020 were reviewed. ResultsOf the 103 z2, a 15 cm stent graft was used in 51 operations. The indications for FET included acute and chronic aortic dissection, arch aneurysms, and pseudoaneurysms. The incidence of SCI was 0%. Seven deaths (13.7%) occurred. ConclusionsThe data demonstrates the incidence of post-operative paraplegia to be 0% with 15 cm z2 FET. The understanding of SCI in FET should not only include the stent length but also from where it begins.

Early outcomes of the Y-incision technique to enlarge the aortic annulus 3 to 4 valve sizes

ObjectiveTo evaluate the safety and efficacy of a novel aortic annular enlargement technique. MethodsFrom August 2020 to February 2022, 50 consecutive cases of aortic valve replacement with Y-incision aortic annular enlargement and other combined cardiac procedures were performed primarily for severe aortic stenosis. Data were obtained through medical record review, The Society of Thoracic Surgeons database, and National Death Index data. ResultsThe median age was 65 (59, 71) years, 70% of patients were female, and 26% had previous cardiac surgery. Sixty-six percent patients had isolated aortic valve replacement. The preoperative mean gradient was 40 (30, 47) mm Hg, and the native aortic annular size was 21 (19, 23) mm. After aortic annular enlargement, the median prosthesis size was 27 (27, 29) with 54% of patients having a size 29 or the largest sized valve. The median increment of annulus enlargement was 3 (3, 4) valve sizes. 88% of patients received no blood transfusion. There were no major postoperative complications, including operative mortality, renal failure requiring permanent dialysis, mediastinitis, or reoperation for bleeding, except for 1 stroke. Three-month postoperative computed tomography aortogram showed the aortic root was enlarged from 27 (24, 30) to 40 (36, 41) mm without aortic pseudoaneurysm. The postoperative mean gradient was 7 (5, 8) mm Hg and valve area was 1.9 (1.7, 2.3) cm2 at 3 to 12 months. Mitral and tricuspid valve functions were significantly improved. Survival was 100% at 18 months. ConclusionsY-incision aortic annular enlargement was safe and effective for upsizing the aortic annulus by 3 to 4 valve sizes.

Very large infrarenal infected aortic pseudoaneurysm in a healthy young patient.

Although rare, infected aortic aneurysms are associated with high morbidity and mortality, despite appropriate treatment.1 An afebrile 33-year-old healthy man had visited the emergency department with a 3-day history of sharp abdominal pain. Initial computed tomography revealed an infrarenal pseudoaneurysm (150 mm; A), deep vein thrombosis from the inferior vena cava to both iliac veins (B and C; red arrows), and left hydronephrosis secondary to extrinsic compression of the ureter (B; blue arrow).

Endovascular ascending aortic pseudoaneurysm repair under image fusion guidance and transcranial Doppler monitoring

We describe a 78-year-old woman with a large ascending aortic pseudoaneurysm who underwent thoracic endovascular aortic repair under intraoperative image fusion guidance and real-time transcranial Doppler (TCD) monitoring. TCD monitoring revealed a total of 419 microembolic signals throughout the procedure, with the majority occurring as the first stent graft crossed the ascending aorta. Two days later, she underwent endovascular repair of a graft type IA endoleak. We highlight the role of image fusion guidance and TCD monitoring in enabling successful thoracic endovascular aortic repair in an elderly woman and in identifying procedural areas of improvement to minimize stroke risk.

470 Cardiac Computed Tomography Prior And After A Transcatheter Occlusion Of An Aortic Pseudoaneurysm With The Amplatzer Device: A Case Report

Introduction: Aortic pseudoaneurysm, after surgical aortic valve replacement (SAVR) is a rare complication, but still remains a reality. Cardiac computed tomography can help differentiate, stratificate and help with the further managment and the feasibility or not, of established therapies.

Misdiagnosis of Thoracic Aortic Emergencies Occurs Frequently Among Transfers to Aortic Referral Centers: An Analysis of Over 3700 Patients.

BackgroundAcute aortic syndromes may be prone to misdiagnosis by nonreferral aortic centers with less diagnostic experience. We evaluated regional variability in these misdiagnosis trends among patients transferred to different regional quaternary care centers with presumed acute aortic syndromes.Methods and ResultsTwo institutional aortic center databases were retrospectively reviewed for emergency transfers in patients diagnosed with acute aortic dissection, intramural hematoma, penetrating aortic ulcer, thoracic aortic aneurysm, or aortic pseudoaneurysm between 2008 and 2020. Transferring diagnoses versus actual diagnoses were reviewed using physician notes and radiology reports. Misdiagnoses were confirmed by a board‐certified cardiothoracic surgeon. A total of 3772 inpatient transfers were identified, of which 1762 patients were classified as emergency transfers. The mean age was 64 years (58% male). Patients were transferred from 203 medical centers by ground (51%) or air (49%). Differences in transfer diagnosis and actual diagnosis were identified in 188 (10.7%) patients. Of those, incorrect classification of Type A versus B dissections was identified among 23%, and 30% of patients with a referring diagnosis of an acute aortic dissection did not have one. In addition, 14% transferred for contained/impending rupture did not have signs of rupture. All misdiagnoses were secondary to misinterpretation of imaging, with motion artifacts (n=32, 17%) and postsurgical changes (n=44, 23%) being common sources of diagnostic error.ConclusionsMisdiagnosis of acute aortic syndromes commonly occurred in patients transferred to 2 separate large aortic referral centers. Although diagnostic accuracy may be improving, there are opportunities for improved physician awareness through standardized web‐based imaging education.

Ascending Aortic Pseudoaneurysm: A Rare Complication of Transcatheter Aortic Valve Replacement and Thoracic Surgery.

Ascending Aortic Pseudoaneurysm: A Rare Complication of Transcatheter Aortic Valve Replacement and Thoracic Surgery.

Hemoptysis and Thoracic Aortic Pseudoaneurysm

Hemoptysis and Thoracic Aortic Pseudoaneurysm

Successful Repair of a Post-opcabg Distal Ascending Aortic Pseudoaneurysm through Lateral Thoracotomy – A Case Report

A large ascending Aortic pseudoaneurysm is a rare life threatening complication after off pump coronary artery bypass surgery. We herein describe such a case of massive ascending Aortic pseudoaneurysm, with impending rupture which was adherent to undersurface of sternum, was successfully treated by us at Square Hospitals Limited. Bangladesh Heart Journal 2022; 37(1): 72-76

Percutaneous approach to treat aortic coarctation and pseudoaneurysm

Percutaneous approach to treat aortic coarctation and pseudoaneurysm

Post-traumatic False Aneurysm of the Aortic Isthmus Revealed by Ortner's Syndrome

Introduction: Left vocal cord palsy by Compression of the left recurrent nerve by the left atrium in tight mitral stenosis defines Ortner's cardio-vocal syndrome. The vascular etiology of compression thoracic aortic aneurysm is well described in the literature. Left vocal cord palsy by Compression of the left recurrent nerve by the left atrium in tight mitral stenosis defines Ortner's cardio-vocal syndrome. The vascular etiology of compression thoracic aortic aneurysm is well described in the literature. Case Record: We present the case of an 80-year-old man with a history of thoracic trauma and recent onset dysphonia and simultaneous discovery of an aortic isthmus pseudoaneurysm and left vocal cord paralysis. Discussion: The place of dysphonia during post traumatic false aneurysm of the aortic isthmus is commented. This observation documents the mechanism of compression of the recurrent left nerve by a post-traumatic false aneurysm of the thoracic aorta. Adequate management can improve the patient's prognosis and quality of life.

Avoiding the re-do sternotomy: treatment of an ascending aortic pseudoaneurysm using a percutaneous Amplatzer PFO closure device.

Ascending aortic pseudoaneurysms are a common phenomenon requiring surgical intervention but can pose high surgical risks in medically complex patients. We report a novel approach to percutaneous closure of ascending aortic pseudoaneurysms using an Amplatzer PFO closure device. We present the case of a 65-year-old male with haemoptysis on a background of multiple cardiac surgeries and chronic kidney disease. Serial computerised tomography scans of the thoracic aorta demonstrated an enlarging ascending aortic pseudoaneurysm. Percutaneous closure was considered the safest treatment option. With angiography, the pseudoaneurysm was defined and a 25mm Amplatzer PFO closure device was deployed. Repeat Computed Tomography aortography performed 43days later confirmed stable device position and resolution of the pseudoaneurysm. The patient was clinically stable at this follow-up point. The off-label use of the Amplatzer PFO device may provide a viable alternative treatment for ascending aortic pseudoaneurysms in medically complex patients to reduce morbidity and mortality.

Aortic pseudoaneurysm on coronary angiography as a cause of complete atrio-ventricular block in COVID-19 patient.

Aortic pseudoaneurysm on coronary angiography as a cause of complete atrio-ventricular block in COVID-19 patient.

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

BACKGROUNDAortoesophageal fistula (AEF) is a rare but life-threatening cause of upper gastrointestinal bleeding. Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported. The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.CASE SUMMARYA 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain, fever and hematemesis for 6 h. He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior. He had a past medical history of advanced esophageal cancer. He received chemoradiotherapy but stopped 8 mo prior because of intolerance. A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm. According to the symptoms and imaging findings, AEF was our primary consideration. The patient underwent aortic angiography, which indicated AEF and descending aortic pseudoaneurysm. Emergency percutaneous thoracic endovascular aortic repair (TEVAR) of the descending aorta was performed, and bleeding was controlled after TEVAR. He received antibiotics and was discharged after treatment. However, he died 2 mo after the TEVAR due to cancer progression.CONCLUSIONAlthough AEF is a lethal condition, timely diagnosis and TEVAR may successfully control bleeding.

Reoperations on the ascending aorta and aortic arch: A retrospective series of 453 patients

ObjectiveThe study objective was to analyze the outcomes of reoperative thoracic aortic surgery at our institution from January 1986 to December 2018 to identify specific risk factors for early and late mortality. MethodsTwo groups of patients were identified: aortic root or ascending aorta repair (group 1: proximal repair, 218 patients, 48%) and arch surgery or descending thoracic aorta repair (group 2: distal repair, 235 patients, 52%). Primary end points were 30-day mortality, 10-year survival, and freedom from aortic reoperations. ResultsThe 30-day mortality (6.4% vs 8.1%) and in-hospital mortality (8.3% vs 11.9%) were similar (P > .05) in the 2 groups. Multivariable analysis identified female gender (odds ratio, 8.60, P < .01), endocarditis (odds ratio, 2.96, P = .04), and cardiopulmonary bypass time (odds ratio, 1.02, P < .01) as risk factors for 30-day mortality. Mean follow-up time was 163 months (confidence interval, 147-179). Long-term survival at 1, 5, and 10 years was 91.2%, 79.4%, and 66.3% in the proximal repair group and 80.7%, 68.8%, the and 55.3% in distal repair group, respectively (P = .03). According to the indication, 1-, 5-, and 10-year survivals were 92.1%, 82.3%, and 68.8% in degenerative aneurysms; 82.7%, 72.4%, and 56.3% in residual dissections; 80.9%, 65.4%, and 50.3% in endocarditis and pseudoaneurysms; 69.2%, 52.7%, and 42.2% in acute type A aortic dissections, respectively (P < .01). Competing risk analysis showed a significantly different cumulative incidence of reoperation at 1, 5, and 10 years between the 2 groups: 0.50%, 0.50%, and 0.90%, respectively, for the proximal repair group, and 0.40%, 4.30%, and 7.70%, respectively, the for distal repair group (P < .01). ConclusionsIn our experience, short- and long-term results of reoperative thoracic aortic surgery were satisfactory in chronic aneurysms but poor in aortic dissections, pseudoaneurysms, and active endocarditis. Reoperative aortic surgery carries a high risk, regardless of the anatomic extension of the procedure.