Pseudoaneurysm Of Ascending Aorta Research Articles

Endovascular treatment of an ascending aorta pseudoaneurysm with an aorta-cutaneous fistula by the transapical approach

Endovascular treatment of an ascending aorta pseudoaneurysm with an aorta-cutaneous fistula by the transapical approach

Surgical management of ascending aorta pseudoaneurysm in a patient with COVID-19

Pseudoaneurysma hrudnĂ­ aorty je raritnĂ­ diagnĂłza asociovanĂĄ s vysokou mortalitou. Prezentujeme případ pacienta, u kterĂŠho vznikla velkĂĄ faleĹĄnĂĄ vĂ˝duĹĽ deset let po provedenĂ­ Bentallovy operace a jednonĂĄsobnĂŠho aortokoronĂĄrnĂ­ho bypassu. ZĂĄroveň s danĂ˝m nĂĄlezem se u něho prokĂĄzala covid-19 pozitivita. Po zaléčenĂ­ pneumonie byla Ăşspěšně provedena operace, a to seĹĄitĂ­m dvou defektĹŻ v aortĂĄlnĂ­m konduitu. JednĂĄ se o unikĂĄtnĂ­ případ, kdy pacient přeĹžil dva Ĺživot ohroĹžujĂ­cĂ­ stavy. © 2023, ČKS.

Innominate Artery Cannulation for Proximal Aortic Surgery.

The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side-graft technique in proximal aortic pathologies. A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an average age of 56±13 years. The indications for surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%), and ascending aorta pseudoaneurysm in one patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). Three patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta with hemiarch replacement in 34 patients (48.5%). The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and 164+56 minutes, respectively. Mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22°C and 30°C during surgery. Thirty-day mortality rate was 7.1% (five patients). One patient (1.4%) had stroke, one patient (1.4%) had temporary neurologic deficit, and eight patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury. Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides satisfactory neurologic outcomes for proximal aortic surgery.

Ascending Aortic Pseudoaneurysm Following Aortic Valve Replacement: A Case Report and Literature Review

Introduction: Ascending aortic pseudoaneurysm (AAP) rupture is a surgical emergency that needs immediate medical and surgical attention and treatment. This rupture can be caused by a variety of risk factors. Prior cardiovascular surgery is a common cause, and prior aortic valve operation is a rare cause. Case Presentation: In this case report, we describe a 47-year-old male with AAP who had a history of aortic valve replacement because of aortic stenosis.

844: SUCCESSFUL TREATMENT OF TRACHEOINNOMINATE ARTERY FISTULA WITH INNOMINATE ARTERY ANGIOPLASTY/STENT

Introduction: Tracheo-innominate artery fistula(TIF) is an uncommon and life-threatening complication of tracheostomy with a reported incidence of 0.7%. However, the mortality rate is nearly 100% if it is not treated urgently with definitive management. The initial bleeding may be mild, but these sentinel bleeding events often precede a massive hemorrhage. Early diagnosis is the most important factor for successful management of a TIF. Here we describe a patient who presented with TIF after sentinel bleeding and whose condition was stabilized with an endovascular stent. Description: 77 year old female with history of severe mitral regurgitation underwent mitral valve repair with annuloplasty; 2 weeks later she developed shortness of breath secondary to ascending aorta pseudoaneurysm which was repaired. Her hospital course was complicated by chronic respiratory failure secondary to recurrent multifocal pneumonia and ARDS, necessitating the need of percutaneous bronchoscopy. Patient had episode of tracheal bleed 3 weeks after the percutaneous tracheostomy for which immediate CT angiography which showed tracheo-innominate artery fistula with sentinel bleed; for which patient underwent successful innominate artery angioplasty and stent with a Gore 8*39 VBX stent. Post angioplasty, fiberoptic bronchoscopy was performed with extensive blood in airways throughout, which was lavaged. The post operative course was uneventful and she was discharged 4 days later to long term acute care. Discussion: The main treatment of TIF is a surgical procedure with ligation of the innominate artery and bypass grafting of the distal innominate artery. Morbidity and mortality rates are high after surgical operations for TIF. Recently, endovascular procedures involving stent graft implantation have significantly improved, and can be safely performed as an alternative to the traditional open surgical method in selected circumstances. Although endovascular stenting does not guarantee the complete elimination of TIF and it has some complications of graft infection, occlusion, and rebleeding due to tracheal erosion. However, endovascular repair of TIF via stent is a safe, effective, and minimally invasive treatment for patients in poor clinical conditions and is an alternative to traditional open surgical treatment.

Ascending Aorta Pseudoaneurysm as a Rare, Late Complication after Valve-in-Valve Transcatheter Aortic Valve Implantation Procedure.

Ascending Aorta Pseudoaneurysm as a Rare, Late Complication after Valve-in-Valve Transcatheter Aortic Valve Implantation Procedure.

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

P107 MULTIMODALITY IMAGING IN ASCENDING AORTA PSEUDO–ANEURYSM COMPLICATED BY MOBILE TROMBUS SYMPTOMATIC FOR RECURRENT ISCHEMIC STROKE

Abstract A 80–year–old male patient was admitted to hospital with a clinical picture of Broca‘s aphasia. The patient had arterial hypertension, diabetes, chronic kidney disease and peripheral vasculopathy. In remote cardiological history he presents long standing persistent atrial fibrillation on OAC and he had a biological aortic valve prosthesis (Medtronic 23). Overall time in the therapeutic range (INR 2.0–2.5) was adequate considering the presence of atrial fibrillation. A CT scan was performed on suspicion of stroke, showing a recent ischemic lesion in the left middle temporal region complicated by same–site subarachnoid blood suffusion. During the hospital stay there was a recurrence of the aforementioned symptoms: at the CT check a new acute ischemic same–site lesion and a new ischaemic lesion at the left temporal site was highlighted. In the suspicion of a cardio–embolic origin of cerebro–vascular events, it was decided to carry out imaging for the study of the aorta and heart cavities to exclude embolic sources. Given the patient‘s comorbidities and the reported allergies (contrast medium with angioedema–like reaction at a previous CT) it was decided to perform transesophageal echocardiography (TEE) first. TEE documented the presence of a saccular aneurysm of probable pseudo–aneurysmatic nature, which extends from 20 mm from the valvular plane, characterized by pedunculated, mobile thrombotic apposition, adhered to the internal collar, projecting into the psueudo–aneurysmatic cavity (image 1). This finding was confirmed and better characterized with the help of the real time three–dimensional echocardiographic method (image 2). To confirm and better characterize the extension of the pseudo–aneurysm and plan any strategy, a CT scan with contrast medium was required. Performing contrast–enhanced CT, after careful preparation with premedication with antihistamine and cortisone, confirmed the finding of pseudo–aneurysm of the ascending aorta, but the pedunculated thrombotic apposition was less clearly evidenced compared with TEE (giving the superior temporal resolution of TEE) (image 3). The case was therefore assessed in Heart Team and the patient was scheduled for surgically exclusion of the pseudo–aneurysm. Conclusion In our case a multimodality imaging approach was used to diagnose and confirm the presence of ascending aorta pseudo–aneurysm complicated by pedunculated thrombotic apposition inside it, symptomatic for recurrent ischaemic stroke.

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.

Combination of a vascular plug and coiling to treat an ascending aortic pseudoaneurysm following aortic surgery

Combination of a vascular plug and coiling to treat an ascending aortic pseudoaneurysm following aortic surgery

Unusual case of pseudoaneurysm of ascending aorta eroding presternal soft tissue and sternum in a patient with miliary tuberculosis and a bioprosthetic aortic valve

Ascending aorta pseudo-aneurysms that erode into the presternal soft tissue and sternum are rare. The author describes the surgical approach of a bulging pulsatile suprasternal mass caused by a pseudoaneurysm of the ascending aorta in a patient with miliary tuberculosis and a bioprosthetic aortic valve.

Very large aortic pseudoaneurysm repair using a septal occluder

A 63-year-old man, with previous coronary artery bypass surgery presented with infectious aortitis and a large ascending aorta pseudoaneurysm, causing compression of the left internal mammary graft. Percutaneous intervention with stenting of the graft followed by closure of the pseudoaneurysm using an atrial septal defect occluder was successfully carried out.

Iatrogenic Ascending Aortic Pseudoaneurysm: A Scarcy Bomb After Coronary Artery Bypass Surgery

Pseudoaneurysma aorty je vzacnou, avsak život ohrožujici komplikaci, s niž se lze setkat několik měsiců nebo i let po operaci na aortě. I když je kardiochirurgický výkon nejcastějsi přicinou, může k vzniku pseudoaneurysmatu vzacně dojit i po urazu a infekci. Klinicke projevy se mohou pohybovat v rozmezi žadne symptomy až katastrofalni výsledek. Průměr a velikost pseudoaneurysmatu aorty se mohou postupem let zvětsovat, což tak může zvysovat riziko jeho nahle ruptury a krvaceni. Popisujeme připad pseudoaneurysmatu vzestupne aorty, vznikleho 13 měsiců po koronarnim bypassu a uspěsně řeseneho chirurgicky. Diagnozu aneurysmatu je nutno stanovit v perioperacnim i pooperacnim obdobi vcas, protože jeho ruptura by měla katastrofalni důsledky.

Repair of ascending aorta pseudoaneurysm presenting as a chest wall swelling.

Repair of ascending aorta pseudoaneurysm presenting as a chest wall swelling.

P700 TEE guidance of percutaneous closure the inlet and exit of ascending aorta pseudoaneurysm in a patient had triple valve replacement

Abstract Funding Acknowledgements none OnBehalf none Introduction Surgical treatment of ascending aortic pseudoaneurysms (AAPA) that develop following cardiac surgery carries significant morbidity and mortality. However, there are emerging reports of transcatheter closure of AAPA. To the best of our knowledge, this is the first reported case where the APA communicates with the left ventricle (LV) cavity with significant diastolic volume overload mimic severe aortic regurgitation. We added to the complications of APA, a fistulous communication with LV causing severe volume overload and heart failure. Case description: Thirty-two years old female underwent mechanical aortic and mitral valve replacement and bioprosthetic tricuspid valve replacement in April 2013. At October 2016, she started to have progressive shortness of breath. TEE revealed large ascending aorta pseudoaneurysm that communicates with LV cavity. Cardiac computed tomography (CT) with contrast revealed a sizeable noncoronary sinus of Valsalva pseudoaneurysm 47mm x 39mm. Surgical excision of the aneurysm decided, but the patient refused any surgical procedure. Percutaneous closure of the inlet and exit of the aneurysm discussed and accepted by the patient. The procedure of transcatheter aneurysm device closure performed successfully with TEE guidance (Figure). A: showed the aneurysm exit to the LV while D: showed its inlet from the aorta. The wire passed the aneurysm inlet at ascending aorta to its outlet in the LV (B). Six mm VSD device deployed closing the aneurysm exit to LV (C). Another 6mm VSD device deployed closing the aneurysm inlet (E). Transgastric long axis aorta view showed no more flow to LV. Midessophageal Short axis view showed no flow between ascending aorta and the aneurysm. Fluoroscopy injection inside the aneurysm (F), another two devices left inside the aneurysm (G). The patient was observed in the cardiac care unit (CCU) for two days, then discharged home in good condition. She was followed in the outpatient clinic after two weeks, and she is doing well with no more shortness of breath. Follow up echo after one year of the procedure showed a small remaining flow from the aneurysmal cavity to the left ventricle. (H and K) compares apical three-chamber view before and one year after closure. Discussion: Preprocedural CT and Intraprocedural TEE are mandatory in determining the size and location of AAPA. Also, the type and size of suitable devices for closure. Overall, the success rate for percutaneous closure is 80%, with a 12% device embolization rate and an 8% failure rate of the transcatheter technique to close the pseudoaneurysm, necessitating conversion to surgical closure. In most reported cases the AAPA had only communication with the aorta. In our case, the AAPA also communicates with the LV cavity that requires the closure of both communications. Conclusion: Percutaneous closure of the inlet and exit of AAPA with TEE guidance is feasible. Long term follow up is required in a large number of patients. Abstract P700 Figure: AAPA device closure

Commentary: A unique presentation of embolic phenomena from an ascending aortic pseudoaneurysm

Ascending aortic pseudoaneurysms (AAPs) are rare, with an incidence reported of only 0.5%. A recent review of literature by Quevedo and colleagues1 identified 355 cases of AAP, 76% that were associated with a history of cardiac or aortic surgery, 5% were attributed to blunt chest trauma, 4.4% were attributed to inflammatory or autoimmune conditions, and 10.6% had no identifiable cause. The same study found that almost 73.8% were treated with open repair, 21.2% underwent endovascular repair, and the remainder were treated conservatively.

Sequential Devices Occlusion of Post-Surgical Ascending Aorta Pseudoaneurysms in a Child, Case Report

Sequential Devices Occlusion of Post-Surgical Ascending Aorta Pseudoaneurysms in a Child, Case Report

Endovascular treatment of non-dissected ascending aorta disease: a systematic review

Severe ascending aorta disease includes aneurysms, pseudoaneurysms (ascending aorta pseudoaneurysms), penetrating aortic ulcers and Type A aortic dissections. Surgical replacement of the aortic root, ascending aorta or aortic arch is the common treatment for severe ascending aortic disease involving the root, the ascending aorta and/or the arch. Despite good surgical results, there is still a risk for morbidity and mortality following surgery for ascending aorta replacement when elderly patients or patients at high risk for surgery are concerned. Less invasive endovascular treatments for ascending aorta repair are under evaluation, and some reports appeared in the available literature in the last decade. However, clinical series or randomized studies are not yet available, and the use of these techniques is still questionable. In this study, we analysed the outcomes of reported cases of endovascular treatment for ascending aorta disease, excluding Type A aortic dissection. We reviewed reports published until February 2017, and we evaluated the employed technology, the devices, the procedural steps and the outcomes. A total of 26 articles reported 67 patients (mean age 65 ± 17 years) who received endovascular treatment for ascending aorta disease: aneurysms, ascending aorta pseudoaneurysms, penetrating aortic ulcers, intramural haematoma, thrombosis, iatrogenic coarctation and aortic rupture. Complications included endoleak (9 cases), stroke (3 cases), non-ST-elevation myocardial infarction (1 case) and splenic infarction (1 case). Three patients required conversion to open surgery, and 1 patient underwent endovascular reintervention. Early mortality was 2.9%. As an alternative treatment for ascending aorta disease in selected high-risk patients, the endovascular repair will gain popularity, but further analysis is required.

Does three‐dimensional transesophageal echocardiography provide incremental value in percutaneous closure of ascending aortic pseudoaneurysm?

Ascending aortic pseudoaneurysms (AO PSAs), if left untreated, are complicated by a high rate of rupture resulting in significant morbidity and mortality. New transcatheter modalities have emerged as acceptable surgical alternatives for their management. We present a case of an ascending aortic PSA in which intraoperative two- and three-dimensional transesophageal echocardiography (2DTEE and 3DTEE) provided a comprehensive assessment of the PSA in pre- and postclosure settings.

Chronic Ascending Aortic Pseudoaneurysm in a Child Secondary to a Retained Palm Frond.

Chronic Ascending Aortic Pseudoaneurysm in a Child Secondary to a Retained Palm Frond.