Successful repair of a postcardiac surgery ascending aortic pseudoaneurysm.

We present the case of a 67-year-old asymptomatic man with a history of coronary artery bypass surgery and a pseudoaneurysm of the ascending aorta treated with a low-risk alternate procedure. At 1-year follow-up, the cardiac computed tomography was not detected residual aneurysm in ascending aorta.

Αn asymptomatic 67‐year‐old man with a 30‐year history of a triple CABG, consisting of left internal thoracic artery to left anterior descending and saphenous vein grafts to the obtuse marginal branch of the circumflex artery and the right coronary artery, was found to have a sizable pseudoaneurysm of the ascending aorta (Figure 1A–C). Redo modified median sternotomy was performed, and a right atrium to right femoral artery cardiopulmonary bypass established. All grafts were patent, firmly adherent to the aorta and the surrounding tissues. The aneurysm was locally excised and repaired with 4/0 polypropylene sutures reinforced with Teflon strips in alignment to the ascending aorta (Figure 2A–C). The patient made an uneventful recovery and was discharged home on the 7th postoperative day. At 1‐year follow‐up, he remains asymptomatic with no signs of recurrence (Figure 3A–C).

FIGURE 1

Preoperative cardiac computed tomography. (A) Pseudoaneurysm of ascending aorta (black arrow) and left internal thoracic artery graft to left anterior descending artery (white arrow). (B) Pseudoaneurysm of ascending aorta (white arrow) and saphenous vena graft form ascending aorta to right coronary artery (red arrow). (C) Pseudoaneurysm of ascending aorta (white arrow), right coronary artery (red arrow), and left main of left coronary artery (green arrow)

FIGURE 2

Operative procedure. (A) Pseudoaneurysm of ascending aorta (black arrow). (B) Partial aortic clamp including the pseudoaneurysm (black arrow). (C) Linear plication of ascending aorta pseudoaneurysm with Teflon strip (black arrow)

FIGURE 3

One‐year follow‐up cardiac computed tomography. (A) Ascending aorta without residual aneurysm (black arrow) and saphenous vena graft form ascending aorta to right coronary artery (red arrow). (B) Ascending aorta without residual aneurysm (black arrow) and saphenous vena graft form ascending aorta to right coronary artery (red arrow). (C) Ascending aorta without residual aneurysm (white arrow) and right coronary artery (red arrow)

Pseudoaneurysms of the AA are rare after cardiac surgery, typically found at cannulation sites or the aortic cross clamp area. Reoperation for bleeding and postoperative infection are common risk factors. Any pseudoaneurysm of the ascending aorta detected, no less a postcardiac surgery one requires urgent treatment in view of life‐threatening complications. ,

AUTHOR CONTRIBUTIONS

All authors contributed equally in carrying out the medical literature and writing the manuscript.

CONFLICT OF INTEREST

None declared.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.