Ann Thorac Surg 2009;88:681. doi:10.1016/j.athoracsur.2008.11.019
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Obstructive Aortic Pseudoaneurysm After Its Prosthetic Replacement Mimicking Type A Dissection
Matteo Pettinari, MDa,
Steven Laga, MDa,*,
Marie-Christine Herregods, MD, PhDb,
Bart Meuris, MD, PhDa,
Paul Sergeant, MD, PhDa
a Department of Cardiac Surgery, Catholic University Hospitals Leuven, Leuven, Belgium
b Department of Cardiology, Catholic University Hospitals Leuven, Leuven, Belgium
* Address correspondence to Dr Laga, Herestraat 49, Leuven, 3000, Belgium (Email: steven_laga{at}yahoo.com).
A 65-year-old woman with a history of aortic valve and supracoronary ascending aorta replacement 1 year earlier was admitted in the emergency department with complaints of sudden retrosternal pain. Electrocardiogram showed T-wave inversion in precordial leads and biochemical examinations showed slight elevated troponin I. Her vital signs and hemodynamic measurements were stable. For initial suspect of acute coronary syndrome she was treated with acetyl salicylic acid and intravenous nitrates. On the next morning she experienced a new episode of retrosternal pain. A computed tomographic scan of the thoracic aorta revealed the presence of an endoluminal flap (Figs 1A and 1B;
arrows) mimicking an image of type A aortic dissection. Immediately after the scan, the patient became hemodynamically unstable and a transesophageal echocardiography confirmed the presence of the flap (Fig 2A;
arrow). Moreover, the ultrasound examination showed partial flow obstruction at the level of the flap. There was turbulent flow in the native root and visible flow in the false lumen (FL) (Fig 2B), which was almost completely obstructing the true lumen (TL) (Figs 2A and 2B). There was normal flow in the descending aorta. Because of hemodynamic instability, emergent surgery was performed. Intraoperatively we found dehiscence of the proximal anastomosis of the graft leading to pseudoaneurysm formation. A tick fibrotic block around the prosthetic graft prevented outward expansion of the pseudoaneurysm, which caused obstruction of the true lumen. So the flap, visualized on the images, was the wall of the graft. A new prosthesis was implanted successfully and the patient recovered fully in 2 weeks.
