Ann Thorac Surg 2001;72:1244
© 2001 The Society of Thoracic Surgeons
Invited commentary
Vincent L. Gott, MDa
a The Johns Hopkins Hospital, Department of Cardiac Surgery, 618 Blalock Building, 600 North Wolfe St, Baltimore, MD 21287-4618, USA
Doctor Choudhary and associates have presented a very interesting article on the extremely rare problem of tubercular pseudoaneurysms of the aorta. I personally have not seen a patient with a tubercular aneurysm in my 35 years at the Johns Hopkins Hospital and, in checking the autopsy records of our hospital back to 1889, only 2 patients are recorded. More than 50,000 autopsies were done during this time period. One of these patients died of a ruptured aneurysm of the upper abdominal aorta and the second patient had a small unruptured aneurysm in the distal thoracic aorta secondary to a large eroding paraaortic lymph node. This latter patient died of diffuse miliary tuberculosis secondary to the eroding lymph node.
Two of Choudhary’s patients received a tubular graft and two received patch grafts; all four of these patients have done well. Their only mortality occurred in patient 3 who had a large pseudoaneurysm of the ascending aorta; direct closure of a small vent in the ascending aorta was carried out without a patch. This patient died 8 months later at a redo operation, which emphasizes that direct closure in this situation was probably not appropriate. Obviously, and they would agree, tubular graft replacement is the procedure of choice in these patients; patch grafting should only be used as a last resort.
Dr Choudhary and colleagues are to be congratulated on their excellent results with this difficult problem.
Related Article
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Tubercular pseudoaneurysms of aorta
- Shiv Kumar Choudhary, Anil Bhan, Sachin Talwar, Mukesh Goyal, Sanjeev Sharma, and Panangipalli Venugopal
Ann. Thorac. Surg. 2001 72: 1239-1244.
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