Ann Thorac Surg 2009;88:682. doi:10.1016/j.athoracsur.2008.10.070
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Giant Pseudoaneurysm of the Ascending Aorta Compressing the Liver in a Patient With Previous Coronary Artery Bypass Grafting
Bashi V. Velayudhan, MCh*,
Kannan R. Nair, MCh,
Harilal Vasu, MCh
Department of Cardiovascular and Thoracic Surgery, MIOT Hospital, Chennai, Tamilnadu, India
* Address correspondence to Dr Velayudhan, Department of CVTS, MIOT Hospital, Chennai, Tamilnadu, 600 089, India (Email: bashivelayudhan{at}gmail.com).
A 58-year-old man presented to our hospital with a history of New York Heart Association functional class III dyspnea and right-sided chest pain radiating to the low back of 2-months duration. In 1992, the patient had coronary artery bypass grafting of two grafts (saphenous vein graft to left anterior descending artery and saphenous vein graft to obtuse marginal 1) for double-vessel coronary artery disease. After a span of 15 years, he started having New York Heart Association functional class II dyspnea, which was progressive in nature, and for which he was on medical treatment by the physician for the last 6 months. His chest roentgenogram revealed an increase in the cardiothoracic ratio, and he was treated for congestive cardiac failure since then. Subsequent ultrasound examination of the abdomen revealed a mass compressing the right lobe of the liver, and he was referred to us for evaluation.
A 64-slice computed tomographic angiogram (Figs 1 and 2)
showed a giant aneurysm of the ascending aorta extending to the right side of the chest, compressing the right lobe of the liver. A conventional coronary angiogram revealed critical left main stenosis with blocked venous grafts and a normal right coronary system. An echocardiogram showed severe left ventricular dysfunction.
A corrective surgical procedure was performed through a re-do median sternotomy after institution of femoro-femoral bypass and profound hypothermia. Under circulatory arrest, the ascending aorta up to the proximal arch was replaced with a collagen-coated woven polyester vascular prosthesis (InterGard [InterVascular, La Ciotat, France]). In addition, the patient had saphenous vein grafts to the left anterior descending coronary artery and obtuse marginal 1. He had an uneventful postoperative recovery.
