Surgery for pseudoaneurysm of the ascending aorta under moderate hypothermia

Abstract

Pseudoaneurysm of the ascending aorta is a rare complication after cardiac surgery. Particularly, pseudoaneurysm due to postoperative infection in the ascending aorta requires surgical treatment with antibiotics. If a large sized pseudoaneurysm is located at the retrosternal space, then there is a very high risk of massive bleeding from rupture during performance of resternotomy. To avoid this risk, we performed femoro-femoral bypass under moderate hypothermia with transient circulatory arrest, and we report here on the successful result of this case.

A Rare Complication: Aorta-Cutaneous Fistula with Abundant Bleeding

“…If the patient's hemodynamic condition permits, especially in the presence of an aorto-cutaneous fistula, urgent diagnosis and necessary intervention should be made. Computerized tomography is very important for early diagnosis and treatment [Auriemma 2006;Jung 2011]. As with our patient, pseudoaneurysm was not detectable with transthoracic echocardiography and angiography; however, it was clearly shown by contrast-enhanced tomographic study.…”

“…Pseudoaneurysms show rare symptoms such as fever, thoracic wall disorders, effects of compression, intermittent retrosternal pain, or embolism [Auriemma 2006;Kim 2008]. They usually occur on graft suture lines and aortotomy and cannulation sites, and infection is an important reason [Arsan 2004;Mohammadi 2005;Auriemma 2006;Jung 2011]. Graft infection or mediastinitis, Marfan syndrome, previous Stanford Type-A acute aortic dissection, trauma, and tuberculosis have been defined as predisposing factors [Bachet 2007].…”

“…The predisposing factors are infection, aortic dissection, connective tissue disorders, chronic hypertension, and aorta calcifications [Auriemma 2006]. As in other aortic aneurysms, pseudoaneurysms may cause life threatening complications such as rupture, formation of fistula, compression of adjacent organs, thrombosis, and embolism [Mohammadi 2005;Auriemma 2006;Jung 2011]. Aorto-cutaneous fistula is a less frequent complication and a fatal situation that also requires rapid diagnosis and aggressive surgical treatment [Kim 2008].…”

Interventional Closure of a Large Pseudoaneurysm of the Ascending Aorta in a Patient after Lung Transplantation

“…Pseudoaneurysm of the ascending aorta is a rare but life-threatening complication in patients undergoing cardiac surgery. 1 Surgical repair of pseudoaneurysms remains the standard treatment. Nevertheless, for patients with extensive aneurysms, urgent indication or renal failure, surgical therapy comes with a high perioperative morbidity and mortality.…”

Double pseudoaneurysms of the aortic bulbus after aortic valve replacement surgery

“…The available medical literature reports an incidence of less than 0.5%, with a high mortality rate (29–46%) [2, 3]. Previous cardiac surgery procedures increase the incidence rate more than 13%.…”