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Paksoy S, Ugan Atik S, Guzeltas A. Transcatheter palliation of aortic pseudoaneurysm in the early post-operative period: "bridge to surgery". Cardiol Young 2023; 33:2128-2129. [PMID: 37138519 DOI: 10.1017/s1047951123000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Aortic pseudoaneurysm is a rare, life-threatening complication that can occur after cardiac surgery, trauma, or infections. Surgical repair of aortic pseudoaneurysm is the conventional treatment, but it is associated with very high morbidity and mortality especially in early post-operative period. However, very limited reports of successful transcatheter repair of aortic pseudoaneurysm related to surgery appear in the literature. Herein, a case of a 9-year-old female who developed a pseudoaneurysm, after aortic reconstruction, that was successfully treated percutaneously using atrial septal occluder is presented.
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Affiliation(s)
- Samet Paksoy
- Department of Pediatric Cardiology, Istanbul Science of Health University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sezen Ugan Atik
- Department of Pediatric Cardiology, Istanbul Science of Health University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Istanbul Science of Health University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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2
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Moosavi J, Ahmadi S, Firouzi A, Sadeghipour P, Mohebbi B, Shafe O, Alizadeasl A, Asadian S, Hoseini M. Cardiac solution for a vascular scenario! CVIR Endovasc 2022; 5:9. [PMID: 35103878 PMCID: PMC8807733 DOI: 10.1186/s42155-021-00280-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ascending aortic pseudoaneurysms (AAPs) constitute a rare, albeit potentially dangerous, condition that occurs in up to 13% of patients after cardiac or aortic surgeries. For patients with a history of cardiac surgery, repeat thoracotomy poses additive risks. The high morbidity and mortality rates associated with the surgical management of AAPs have led to the development of transcatheter approaches. CASE REPORT We report a case of AAP percutaneous closure at the site of aortic cannulation with an ASO device in a post-CABG 65-year-old man, who refused surgery. CONCLUSION The use of the Amplatzer Atrial Septal Defect Occluder (ASO) device represents an acceptable alternative to surgery in treatment of Ascending aortic pseudoaneurysms.
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Affiliation(s)
- Jamal Moosavi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Somaye Ahmadi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Ata Firouzi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parham Sadeghipour
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Shafe
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadeasl
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Asadian
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehran Hoseini
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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3
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Sivakumar K, Sheth R, Kurien VM, Anbarasu M. Tailored approaches for transcatheter closure of postsurgical pseudoaneurysms from the ascending aorta and brachiocephalic artery. J Cardiol Cases 2020; 23:238-241. [PMID: 33995706 DOI: 10.1016/j.jccase.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/04/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022] Open
Abstract
Ascending aortic pseudoaneurysms following open-heart surgery are treated by redo surgery or endovascular therapy when surgical risks are high. Extreme variations in their morphology, proximity to coronary and arch branches and vascular access may vary the timing, strategy, device choice, and technique in each patient. Three patients with varying etiology, presentations, and morphology of the pseudoaneurysms underwent successful endovascular exclusion by individually tailored strategies. The approach includes optimal treatment of the underlying infections before the endovascular intervention despite the emergency to treat the condition; choosing appropriate device depending on the proximity to aortic branches, choosing appropriate access depending on the angulation of the entry of pseudoaneurysm to the aortic lumen, and use of adequate imaging for achieving procedural success. <Learning objective: A tailored approach for transcatheter closure of postsurgical ascending aortic pseudoaneurysms should include: 1 Optimal infection control before the intervention. 2 Choosing nitinol occluders in high-flow aneurysms; vascular plugs and coils for residual leaks; and embolic protection for high clot burden. 3 Choice of femoral, brachial, or transapical access is decided based on angulation of the aneurysm with ascending aorta. 4 Meticulous planning of the interventions based on advanced three-dimensional imaging.>.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A, Dr JJ Nagar, Mogappair, Chennai 600037, India
| | - Ronak Sheth
- Department of Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A, Dr JJ Nagar, Mogappair, Chennai 600037, India
| | | | - Mohanraj Anbarasu
- Department of Cardiac Surgery, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
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Celik O, Sahin AA, Erturk M. Percutaneous closure of pseudoaneurysm of the descending thoracic aorta with septal device occlusion technique. Anatol J Cardiol 2020; 24:54-6. [PMID: 32628139 DOI: 10.14744/AnatolJCardiol.2020.59251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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5
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Tipaldi MA, Orgera G, Krokidis ME, Laurino F, Capuano F, Rossi M. Postoperative ascending aortic gigantic pseudoaneurysm: Endovascular treatment with the use of a septal occluder plug. Interv Med Appl Sci 2018; 10:213-215. [PMID: 30792916 PMCID: PMC6376348 DOI: 10.1556/1646.10.2018.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A rare postoperative complication of aortic root replacement is pseudoaneurysm formation. Surgical repair may be rather challenging particularly in patients who are elder and with significant comorbidities. Endovascular approach may also be technically demanding, given the high blood velocity and the anatomical challenges of the area of the aortic root and the ascending aorta. We would like to describe a case of an 85-year-old patient with history of prosthetic graft aortic root replacement who had been developed a 7-cm pseudoaneurysm with sternotomy diastasis and extension in the subcutaneous tissue, 7 years after the initial operation. Given the comorbidities, open repair was not considered a valid option and successful endovascular repair with the use of a ventricular septal occluder plug followed. One-year follow-up confirmed satisfactory exclusion of the pseudoaneurysm with no migration of the endovascular device and no other complication. This is one of the rare cases on endovascular repair of an ascending aorta postoperative pseudoaneurysm.
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Affiliation(s)
| | - Gianluigi Orgera
- Department of Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Miltiadis E Krokidis
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Florindo Laurino
- Department of Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Fabio Capuano
- Department of Cardiac Surgery, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Michele Rossi
- Department of Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
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Abstract
One of the most challenging conditions to manage after previous cardiac surgery is chronic dissection of the ascending aorta. We operated on a 54-year-old man who had aortic dissection in addition to large aortic dimensions very close to the sternum, severe aortic regurgitation, and a false lumen in the descending aorta. We used a combination of perfusion and myocardial protection techniques, arising from port-access technology, that enabled antegrade flow into the aorta, endoclamping of the ascending aorta, the administration of cardioplegic solution before opening the sternum, and left ventricular venting to prevent ventricular distention. Our technique resulted in minimal blood loss, shorter circulatory-arrest and operative times, the ability to operate on a decompressed heart and descending aorta, good myocardial protection, and easier and safer access to the heart. Three years postoperatively, our patient was doing well. Other patients might benefit from this approach; however, the surgeon must ensure that an aortic segment is suitable for endoclamping.
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Abstract
In reoperation for an ascending aortic pseudoaneurysm eroding through the sternum, a left ventricular vent allows careful unhurried sternal division under deep hypothermic circulatory arrest. We repaired ascending aortic pseudoaneurysms in 2 patients who had undergone aortic valve implantation 6 and 21 months earlier. A minithoracotomy was made in the left 5th intercostal space, and a vent was placed in the left ventricular apex. Repair was accomplished with a bovine pericardial patch reinforced with a Teflon felt strip. Both patients made an uneventful recovery with good functional status at discharge at the 8- and 18-month follow-up.
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Affiliation(s)
- Sulaiman B Hasan
- 1 Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Fazal W Khan
- 1 Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shiraz Hashmi
- 1 Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammad Tariq
- 1 Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Deshpande S, Godbole RC, Godbole YR. Percutaneous closure of aortic pseudoaneurysm in a young female with atrial septal occluder. J Cardiol Cases 2017; 15:39-42. [PMID: 30546692 PMCID: PMC6283732 DOI: 10.1016/j.jccase.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/01/2016] [Accepted: 10/06/2016] [Indexed: 11/21/2022] Open
Abstract
This case report represents a novel technique for the treatment of a pseudoaneurysm of the aorta. Pseudoaneurysm of the aorta has been reported in patients post heart surgery. This case report is about a patient who had a pseudoaneurysm most probably following tuberculosis. Traditionally, the treatment of choice is surgical correction; however, in the current era, there are case reports describing the use of either stent grafts or Amplatzer occluders for occlusion of the pseudoaneurysm in high-risk surgical cases. We performed successful closure of the aortic pseudoaneurysm using atrial septal occluder. .
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Affiliation(s)
- Shantanu Deshpande
- Padmashree Dr D Y Patil Medical College, Nerul, Navi Mumbai, Maharashtra, India
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Nogueira MA, Fiarresga A, de Sousa L, Galrinho A, Santos N, Nobre I, Laranjeira Á, Cruz Ferreira R. Percutaneous closure of a large ascending aortic pseudoaneurysm. Rev Port Cardiol 2016; 35:119.e1-5. [PMID: 26852307 DOI: 10.1016/j.repc.2015.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/13/2015] [Accepted: 10/16/2015] [Indexed: 11/26/2022] Open
Abstract
Pseudoaneurysm of the ascending aorta is a rare complication, usually after thoracic surgery or trauma. Since surgical repair is associated with very high morbidity and mortality, percutaneous closure has been described as an alternative. In this regard, we present a case in which a symptomatic large pseudoaneurysm of the ascending aorta was treated percutaneously due to the high surgical risk. Despite the technical difficulties, this procedure had a good final result followed by clinical success.
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Affiliation(s)
| | | | - Lídia de Sousa
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Ana Galrinho
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Ninel Santos
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Isabel Nobre
- Department of Radiology, Lusíadas Hospital, Lisbon, Portugal
| | - Álvaro Laranjeira
- Department of Cardiothoracic Surgery, Santa Marta Hospital, Lisbon, Portugal
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Nogueira MA, Fiarresga A, de Sousa L, Galrinho A, Santos N, Nobre I, Laranjeira Á, Cruz Ferreira R. Percutaneous closure of a large ascending aortic pseudoaneurysm. Revista Portuguesa de Cardiologia (English Edition) 2016; 35:119.e1-119.e5. [DOI: 10.1016/j.repce.2015.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ruggieri VG, Malezieux R, Bina N, Favre JP. Hybrid treatment of an ascending aortic pseudoaneurysm following multiple sternotomies. J Vasc Surg 2010; 51:729-31. [DOI: 10.1016/j.jvs.2009.08.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Revised: 07/28/2009] [Accepted: 08/29/2009] [Indexed: 10/19/2022]
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Abstract
BACKGROUND Resternotomy during closed chest cardiopulmonary bypass in hypothermia with or without circulatory arrest has been the preferred method for cardiac reoperations with adherent structures to the sternum. Here, we report our experience with this method and the effects of omitting ventricular decompression during the cooling procedure. METHODS Twenty reoperations were performed in 19 patients. In half (n = 10) of the procedures aortic regurgitation was present. Cardiopulmonary bypass was instituted in all patients before resternotomy, and the re-entry into the chest was performed either under hypothermic low-flow cardiopulmonary bypass or circulatory arrest. The reason for this choice of technique was adherent structures to the sternum posing a substantial risk for rupture during resternotomy in all patients. RESULTS Rupture upon re-entry into the chest occurred in five operations. No patient died due to re-entry injury. The overall hospital mortality was 15%. No differences in postoperative outcomes including heart failure, biochemical markers indicating myocardial damage, and three-month follow-up assessment of cardiac function were found between patients with aortic regurgitation and patients without aortic regurgitation. CONCLUSIONS Based on our experience, omitting ventricular decompression in resternotomy in hypothermia and arrested circulation or low-flow cardiopulmonary bypass can be safely used, and the presence of aortic regurgitation does not seem to influence the outcome.
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Affiliation(s)
- Fanny Möller
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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Stasek J, Polansky P, Bis J, Brtko M, Klzo L, Babu A, Vojacek J. The percutaneous closure of a large pseudoaneurysm of the ascending aorta with an atrial septal defect Amplatzer occluder: two-year follow-up. Can J Cardiol 2008; 24:e99-e101. [PMID: 19052684 DOI: 10.1016/s0828-282x(08)70703-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pseudoaneurysm of the ascending aorta is a high-risk complication following cardiac surgery. The present report describes excellent two-year follow-up results after the percutaneous closure of a very large pseudoaneurysm with an Amplatzer atrial septal defect occluder. The original cavity in the anterior mediastinum with maximal diameter 15 cm remained as only a small scar. The patient was without serious health problems both early and after two years.
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Bachet J, Pirotte M, Laborde F, Guilmet D. Reoperation for Giant False Aneurysm of the Thoracic Aorta: How to Reenter the Chest? Ann Thorac Surg 2007; 83:1610-4. [PMID: 17462366 DOI: 10.1016/j.athoracsur.2006.12.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 11/06/2006] [Accepted: 12/27/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Giant false or pseudoaneurysm of the aorta is a rare but dreadful complication occurring several months or years after cardiac or aortic surgery. We describe a surgical approach that allowed safe reentry in the chest in five patients, with a mean follow-up of almost seven years. METHODS From December 1991 to October 1999, five patients aged 34 to 74 years (mean age, 55 +/- 11.6 years), who had previously undergone a total of nine operations in other institutions, required reoperation for giant false aneurysm of the ascending aorta in a mean delay of 22.6 +/- 20.3 months (3 months to 6 years) after the last surgical procedure. In order to avoid major mediastinal wound and patient's exsanguination during resternotomy, the following technique has been used: femoral artery cannulation; right atrial cannulation through the femoral vein; femoro-femoral full-flow cardiopulmonary bypass; rectal temperature lowered to 25 degrees C; direct cannulation and cross-clamping of both carotid arteries through a direct cervical approach, and selective cerebral perfusion with cold blood (10 degrees C to 12 degrees C); circulatory arrest of the main circuit; chest opening; and mediastinal division. RESULTS Despite the fact that the false aneurysm was entered in all patients, reopening of the chest has been safe in all cases. In four cases, the aortic repair consisted of complete graft replacement (Dacron) of the compromised aortic segment (ascending aorta in two; both ascending aorta and aortic arch in two). In one case, reimplantation of the left coronary ostium and closure of a fistula with the left ventricle was carried out. One patient with ongoing mediastinitis died from intractable septicemia and multiorgan failure. Presently, two patients are in excellent condition; one suffers from light neurologic sequelae (oculomotor nerves palsy) and one patient had a nonrelated stroke one year postoperatively. CONCLUSIONS The technique of separate carotid cannulation and selective antegrade brain perfusion with cold blood during circulatory arrest at moderate core hypothermia has, in our opinion, many advantages. In addition to allowing harmless opening of the chest in the presence of most dangerous mediastinal false aneurysms, it implies no general deep hypothermia, reduced duration of cardiopulmonary bypass, and circulatory arrest of the lower part of the body, and safe and permanent brain protection throughout chest opening and mediastinal division. It has allowed us to safely reoperate on patients who are generally considered as a major surgical risk.
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Affiliation(s)
- Jean Bachet
- Département de Pathologie Cardiaque, Institut Mutualiste Montsouris, Paris, France.
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Atik FA, Navia JL, Svensson LG, Vega PR, Feng J, Brizzio ME, Gillinov AM, Pettersson BG, Blackstone EH, Lytle BW. Surgical treatment of pseudoaneurysm of the thoracic aorta. J Thorac Cardiovasc Surg 2006; 132:379-85. [PMID: 16872966 DOI: 10.1016/j.jtcvs.2006.03.052] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 02/24/2006] [Accepted: 03/08/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta. METHODS From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneurysm: ascending aorta in 70%, ascending aorta and arch in 15%, descending aorta in 10%, and arch alone in 5%. Mean age was 53 +/- 15 years, and 70% were men. Of these, 50 (83%) had undergone previous cardiac surgery, including 22 (37%) composite valve graft operations. The preferred cannulation site was femoral-femoral (n = 27, 45%), with deep hypothermic circulatory arrest in 62% and retrograde cerebral perfusion in 33%; more recently, however, axillary cannulation has been preferred. RESULTS Principal etiologies were graft infection in ascending aorta pseudoaneurysm and trauma in descending aorta pseudoaneurysm. Fifteen patients (25%) presented with chest pain, 13 (22%) with heart failure, and 20% with moderate or severe aortic regurgitation. The pseudoaneurysm was resected and the aorta replaced (n = 45, 75%) or repaired (n = 15, 25%) using various methods. Hospital mortality was 6.7% (n = 4). Reexploration for bleeding was required in 8.3%, and 3.3% had postoperative stroke. At 30 days, 5 years, and 10 years, survival was 94%, 74%, and 60% and freedom from reoperation was 95%, 77%, and 67%, respectively. CONCLUSIONS Most patients with aortic pseudoaneurysm require ascending aorta and/or arch replacement, which can be accomplished with low operative mortality and morbidity. Long-term survival and freedom from reoperation in these young patients parallel those expected for complex cardiac and aortic disease.
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Affiliation(s)
- Fernando A Atik
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
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Villavicencio MA, Orszulak TA, Sundt TM, Daly RC, Dearani JA, McGregor CGA, Mullany CJ, Puga FJ, Zehr KJ, Schaff HV. Thoracic Aorta False Aneurysm: What Surgical Strategy Should Be Recommended? Ann Thorac Surg 2006; 82:81-9; discussion 89. [PMID: 16798195 DOI: 10.1016/j.athoracsur.2006.02.081] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2005] [Revised: 02/18/2006] [Accepted: 02/27/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thoracic aorta false aneurysms (TAFA) are a surgical challenge. The best technical approach remains uncertain. METHODS Between 1981 and 2004, 57 patients underwent operation for TAFA (mean age 57 +/- 18 years; 43 [75%] were male). Symptoms included dyspnea 25 (44%), chest pain 22 (39%), and fever 18 (32%). Twelve (21%) were asymptomatic. Thirty-seven (65%) had undergone previous operation with a mean interval between operations of 80 +/- 90 months. Fifteen (26%) had a mycotic etiology. The TAFA involved the aortic root in 10 (18%), ascending aorta in 28 (49%), arch in 6 (11%), and descending aorta in 13 (32%). Twenty-one (37%) required femorofemoral cannulation and 28 (49%), circulatory arrest. Surgical techniques included graft replacement in 27 (47%), composite root in 10 (18%), patch repair in 10 (18%), and direct suture in 10 (18%). RESULTS Operative mortality was 7% (4 patients). Four of 32 (13%) had massive hemorrhage during redo sternotomy, and all of these had planned extramediastinal cannulation (all survived). Follow-up was 100% for 349 patient-years. Actuarial survival was 77% +/- 6%, 63% +/- 8%, and freedom from recurrent TAFA was 87% +/- 5% and 83% +/- 7%, at 5 and 10 years, respectively. Univariate analysis identified TAFA greater than 55 mm, urgent operation, and NewYork Heart Association functional class III or IV as predictors of hemorrhage during redo sternotomy. Obesity and ejection fraction of 35% or less were predictors of operative death. CONCLUSIONS Thoracic aorta false aneurysm symptoms may be minimal, and consequently a high degree of suspicion plus serial imaging is warranted. Extramediastinal cannulation, deep hypothermia, and circulatory arrest are required for large mediastinal TAFA. Despite serious risks, TAFA correction is possible with good long-term results.
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MESH Headings
- Adult
- Aged
- Aneurysm, False/mortality
- Aneurysm, False/pathology
- Aneurysm, False/surgery
- Aneurysm, Infected/drug therapy
- Aneurysm, Infected/mortality
- Aneurysm, Infected/pathology
- Aneurysm, Infected/surgery
- Anti-Bacterial Agents/therapeutic use
- Aorta, Thoracic/pathology
- Aorta, Thoracic/surgery
- Aortic Aneurysm, Thoracic/drug therapy
- Aortic Aneurysm, Thoracic/mortality
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/surgery
- Aortic Diseases/mortality
- Aortic Diseases/pathology
- Aortic Diseases/surgery
- Blood Loss, Surgical
- Blood Vessel Prosthesis
- Combined Modality Therapy
- Comorbidity
- Emergencies
- Female
- Humans
- Life Tables
- Male
- Middle Aged
- Postoperative Complications/mortality
- Postoperative Complications/pathology
- Postoperative Complications/surgery
- Recurrence
- Retrospective Studies
- Risk Factors
- Sternum/surgery
- Survival Analysis
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Auriemma S, Magagna P, Sallam A, Lamascese N, Fabbri A. Repair of ascending aorta pseudoaneurysm without circulatory arrest in redo patient. World J Emerg Surg 2006; 1:2. [PMID: 16759401 PMCID: PMC1459263 DOI: 10.1186/1749-7922-1-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 03/24/2006] [Indexed: 11/17/2022] Open
Abstract
A pseudoaneurysm of the ascending aorta is an unusual and potentially fatal complication after aortic surgical operations. TEE and CT scan are the investigations of choice. Surgical treatment is mandatory. We describe the successful management of a pseudoaneurysm of the ascending aorta, with aorto-sternal-cutaneous fistula requiring right axillary and femoral artery cannulation with Remote Access Perfusion® aortic cannula (Estech®, California, USA). Behaving like this we avoid hypotermic circulatory arrest, provide safe reentry and prevent an impending rupture.
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Affiliation(s)
- Stefano Auriemma
- Division of Cardiac Surgery San Bortolo Vicenza Hospital, Vicenza, Italy
| | - Paolo Magagna
- Division of Cardiac Surgery San Bortolo Vicenza Hospital, Vicenza, Italy
| | - Ayman Sallam
- Division of Cardiac Surgery San Bortolo Vicenza Hospital, Vicenza, Italy
| | - Nicola Lamascese
- Division of Cardiac Surgery San Bortolo Vicenza Hospital, Vicenza, Italy
| | - Alessandro Fabbri
- Division of Cardiac Surgery San Bortolo Vicenza Hospital, Vicenza, Italy
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Maselli D, Santise G, Montalto A, Musumeci F. Endovascular Aortic Clamping for Pseudoaneurysms of the Aortic Root With Aortic Regurgitation. Ann Thorac Surg 2005; 80:1303-8. [PMID: 16181859 DOI: 10.1016/j.athoracsur.2005.02.090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2004] [Revised: 01/21/2005] [Accepted: 02/01/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND We propose a safer strategy for surgical treatment of retro-sternal pseudoaneurysms of the aortic root with severe aortic regurgitation. The objective was to allow safer re-entry in a quite and bloodless field eliminating the risk of ventricular distension and avoiding deep hypothermia. METHODS In 6 patients presenting with postsurgical aortic root pseudoaneurysms in close proximity to the sternum associated with aortic regurgitation, we used the following techniques: femorofemoral cardiopulmonary bypass; transfemoral aortic endoclamping; percutaneous retrograde cardioplegia administration before sternotomy in patients with normal descending aorta; femoroaxillary cardiopulmonary bypass; transaxillary aortic endoclamping; percutaneous retrograde cardioplegia administration before sternotomy in patients with concomitant disease of the descending aorta. RESULTS All patients survived the operation and were discharged home. Arterial cannulation and endoclamp insertion were uneventful. Reentry was uncomplicated. Deep hypothermia was avoided in all cases. No occurrences of even minor neurologic problems were observed. None of these patients experienced a postoperative low cardiac output syndrome. Postoperative course was complicated in 1 patient with re-entry for bleeding; acute renal insufficiency requiring hemofiltration in 2 patients; pneumonia in 1 patient; and soft tissues sternotomy infection in 1 patient. CONCLUSIONS In patients presenting with a pseudoaneurysm of the aortic root attached to the sternum and concomitant aortic regurgitation it is possible, by closed chest endovascular aortic clamping, to eliminate risks of ventricular distension and to avoid deep hypothermia.
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Affiliation(s)
- Daniele Maselli
- Department of Cardiac Surgery, San Camillo Hospital, Rome, Italy.
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Maselli D, Musumeci F. Transaxillary Aortic Endoclamping for Ascending Aortic Pseudoaneurysm and Dissected Descending Aorta. Ann Thorac Surg 2005; 79:e36-8. [PMID: 15919264 DOI: 10.1016/j.athoracsur.2004.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2004] [Indexed: 10/25/2022]
Abstract
Patients presenting with pseudoaneurysm of the aortic root close to the sternum, severe aortic regurgitation, and chronic dissection of the descending aorta represent a formidable surgical challenge. Closed chest circulatory arrest in this setting carries a high risk of myocardial or brain damage. We propose a modification of the port-access technique that allows control and access of the pseudoaneurysm, avoiding the need for closed chest circulatory arrest. Our strategy is based on transaxillary endoclamping of the ascending aorta and combines the advantages of antegrade aortic flow with the possibility of stopping the heart and venting the left ventricle before sternotomy.
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Affiliation(s)
- Daniele Maselli
- Department of Cardiac Surgery, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy.
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Warnecke H, Franz N, Roethemeyer S, Ritter F, John AT, Thale J. Preoperative Balloon Sealing of a False Ascending Aortic Aneurysm for Safe Redo Sternotomy. Ann Thorac Surg 2005; 79:2166-8. [PMID: 15919342 DOI: 10.1016/j.athoracsur.2004.01.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2004] [Indexed: 11/29/2022]
Abstract
Sternal contact of aortic aneurysms in redo operations may require specific techniques to safely control bleeding during sternotomy and surgical dissection. This is the first report on the preoperative use of an inflatable balloon to prevent massive hemorrhage by inserting the balloon--a procedure performed in the cardiac catheterization laboratory--before rethoracotomy. A false ascending aortic aneurysm was successfully sealed by transaortic wire-guided balloon placement from the iliac artery. Gentle traction on the inflated balloon catheter, which was placed inside the false aneurysm, effectively sealed the entrance to the aneurysm. A straightforward median redo sternotomy procedure was subsequently performed without blood loss from the unavoidably opened aneurysm. My colleagues and I propose this technique for aneurysms of mycotic or anastomotic origin, which have an anatomically distinct entry channel.
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Affiliation(s)
- Henning Warnecke
- Department of Cardiac Surgery, Schuechtermann-Klinik, Bad Rothenfelde, Germany.
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Abstract
A pseudoaneurysm of the ascending aorta is an unusual and potentially fatal complication after aortic surgical procedures. A contrast computed tomographic scan is the investigation of choice. Surgical treatment is mandatory. We describe the successful management of a pseudoaneurysm of the ascending aorta by instituting femorofemoral bypass and achieving hypothermic circulatory arrest, which provided safe reentry and prevented an impending rupture.
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Affiliation(s)
- Bhawna Parihar
- Department of Thoracic and Cardiovascular Surgery, Christian Medical College and Hospital, Vellore, India
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Bashir F, Quaife R, Carroll JD. Percutaneous closure of ascending aortic pseudoaneurysm using Amplatzer septal occluder device: The first clinical case report and literature review. Catheter Cardiovasc Interv 2005; 65:547-51. [PMID: 15973675 DOI: 10.1002/ccd.20422] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report the first case of the use of an Amplatzer septal occluder device to close a large ascending aortic pseudoaneurysm. The patient had a complex cardiac history with redo coronary artery bypass graft surgery, severe left ventricular dysfunction, and end-stage renal disease requiring hemodialysis. The procedure was successfully performed under fluoroscopic and 2D/3D transthoracic echocardiographic guidance. Six-week follow-up with both transthoracic echocardiography and MRI showed the device was in proper position with complete closure of the pseudoaneurysm.
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Affiliation(s)
- Faran Bashir
- Division of Cardiology, University of Colorado Health Sciences Center, Denver, CO 80262, USA
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Abstract
Median sternotomy in the setting of aortic pseudoaneurysm and/or rupture is hazardous, requiring technical modifications to prevent exsanguination. Free aortic disruption, particularly when accompanied by aortic regurgitation, presents a particularly challenging situation. The critical issue is to protect the brain and heart while obtaining control of the aorta. We report management of such a case using transfemoral balloon aortic occlusion.
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Affiliation(s)
- Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Abstract
Pseudoaneurysms in the ascending aorta most commonly occur as a complication of surgical procedures at this site. They have also been reported in association with trauma, infection, aortitis, and other disorders. Pseudoaneurysm formation in the descending aorta or arch may occur as a result of penetrating ulcers in the presence of severe atherosclerotic plaque. Pseudoaneurysm as a result of atherosclerotic disease has only rarely been noted in the ascending aorta, where complex plaque is less common. We report here the finding with transesophageal echocardiography of a pseudoaneurysm in the ascending aorta as a result of atherosclerotic disease and penetrating ulcer.
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Affiliation(s)
- Robert N Belkin
- Division of Cardiology, New York Medical College and Westchester Medical Center, USA
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Abstract
Big pseudoaneurysms of the ascending aorta after a previous thoracic operation are rare and represent a surgical challenge. Because the rupture during sternal reentry occurs before the clamp-control of the distal ascending aorta, it is essential to control the bleeding until the adhesions are released in order to place the sternal retractor. We report the use of Foley catheter with a malleable guidewire to control the bleeding from the defect in the ascending aorta causing a pseudoaneurysm in case of a limited access.
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Affiliation(s)
- Anil Z Apaydin
- Department of Cardiovascular Surgery, Ege University Medical School, Izmir, Turkey.
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