Ascending aortic pseudoaneurysm after aortic valve replacement: Watch the tip of the cardioplegia cannula!

Surgery for pseudoaneurysm of the ascending aorta under moderate hypothermia

“…The ascending aortic pseudoaneurysm mainly bulges anteriorly while eroding the boney structures of the sternum. Although rarely reported, ascending aortic pseudoaneurysm can occur posteriorly from an injury caused by a cardioplegia cannula [7]. …”

Asymptomatic Mycotic Aneurysm of Ascending Aorta After Heart Transplantation: A Case Report

“…Applying femoral CPB and subsequent decompression of the aneurysm may be a relatively safe entry to the chest, with the assurance that CPB would stabilize the patient if the aorta was inadvertently damaged during re-entry. However, some surgeons believe that opening the sternum with femoral CPB and total circulatory arrest is the strategy of choice [11].…”

A dental mirror provides excellent exposure of the right coronary artery during cardioplegia

“…In these cases, it is sometimes very difficult to achieve good exposure of the orifice of the right coronary artery through a typical aortotomy when inserting the cannula for the selective antegrade administration of cardioplegic solution to the RCA. Rough blind manoeuvering of the cardioplegic cannula is very dangerous, and there have been reports of coronary artery ostial dissection [1] and pseudoaneurysms possibly caused by the tip of the cardioplegic cannula [2]. Retrograde administration of cardioplegic solution through the coronary sinus is another possibility for inducing cardioplegia, especially when there is critical stenosis of the coronary arteries [3,4].…”