Ascending aorta graft pseudoaneurysm and aortobronchial fistula caused by a fractured sternal wire: a case report

Abstract

Background Pseudoaneurysm of ascending aorta is a rare but serious complication of cardiovascular surgeries and it infrequently occurs in the normal prosthetic graft materials. We share our experience with an unusual case of ascending aorta Dacron graft pseudoaneurysm caused by a fractured sternal wire. Case presentation A 34-year-old man, known case of Marfan syndrome, with history of two prior aortic surgeries for aneurysm of ascending aorta, arch and thoracoabdominal aorta, presented with hemoptysis. The hemoptysis originated from an aortobronchial fistula secondary to a huge ascending aorta Dacron graft pseudoaneurysm. The graft erosion and subsequent pseudoaneurysm was caused by a fractured sternal wire. Surgical repair of the pseudoaneurysm was performed successfully and a Gore-tex patch was placed behind the sternum over the graft to prevent further direct contact of the wire and the graft. Conclusion Sternal wires can damage the adjacent vascular grafts and lead to fatal complications such as pseudoaneurysm formation. Thus, preventive measures such as using sternal bands and placing a covering layer between the sternal wires and aortic grafts are recommended in patients with dilated or replaced ascending aorta.

Ascending aortic graft penetration by fractured sternal wire: A word of caution

“…However, the sharp edge of fractured wire can damage surrounding structures, which may result in catastrophic bleeding. According to previously reported cases, aortic graft injury complicated with massive bleeding and pseudoaneurysmal formation necessitated open surgical repair 1,2 . Fortunately, no bleeding was observed around the penetration in the present case, cardiovascular surgeons should keep in mind that a fractured sternal wire can injure surrounding structures.…”