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Neth Heart J. 2010 August; 18(7-8): 381.
PMCID: PMC2922788

Giant pseudoaneurysm after aortic root replacement

A 22-year-old woman was born with a bicuspid aortic valve. Initially she underwent a valvulotomy, followed by a Ross procedure nine years later. Because of dilation of the autograft, a root replacement was performed with a Freestyle stentless bioprosthesis. The procedure was complicated by a sterile, probably biological glue-induced, mediastinitis.

Six months later she started to complain about chest pain. A CT scan revealed a large pseudoaneurysm (figure 1). The aneurysm originated from the distal connection of the prosthesis, for which an interposition tube graft was placed under hypothermic circulatory arrest. Recovery was uneventful.

Figure 1Figure 1
A) A CT scan demonstrated a large pseudoaneurysm, originating from the connection of the Freestyle prosthesis with the native aorta. B) The aneurysm had thrombus adjacent to the wall with a centre showing normal contrast density. The vena cava superior ...

Pseudoaneurysm of the ascending aorta is rare after cardiac surgery (<0.1%).1 It is suggested that the use of biological glue and postsurgical mediastinitis lead to intramural inflammation and aortic degeneration and are therefore risk factors for pseudoaneurysm formation.2-4 In our patient the development of symptoms revealed the diagnosis of pseudoaneurysm. A CT scan a few months later should be considered in patients with a mediastinitis after root replacement.

References

1. Taylor PC, Groves LK, Loop FD, Effler DB. Cannulation of the ascending aorta for cardiopulmonary bypass: experience with 9,000 cases. J Thorac Cardiovasc Surg. 1976;71:255-8. [PubMed]
2. Katsumata T, Moorjani N, Vaccari G, Westaby S, Mediastinal false aneurysm after thoracic surgery. Ann Thorac Surg. 2000;70:547-52. [PubMed]
3. Kazui T, Mitsunaga Y, Fukuhiro Y, Nakajima T, Okabayashi H. Aortic root reimplantation using a Valsalva graft for postoperative pseudoaneurysm after acute aortic dissection. Ann Thorac Cardiovasc Surg. 2008;14:339-42. [PubMed]
4. Schouten LR, Verberne HJ, Bouma BJ, van Eck-Smit BL, Mulder BJ. Surgical glue for repair of the aortic root as a possible explanation for increased F-18 FDG uptake. J Nucl Cardiol. 2008;15:146-7. [PubMed]

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