Premium
Pseudoaneurysms of the Ascending Aorta Following Coronary Artery Bypass Surgery
Author(s) -
Dhadwal Ajay K.,
Abrol Sunil,
Zisbrod Zvi,
Cunningham Joseph N.
Publication year - 2006
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2006.00220.x
Subject(s) - medicine , pseudoaneurysm , ascending aorta , surgery , median sternotomy , presentation (obstetrics) , cardiopulmonary bypass , past medical history , aneurysm , mediastinitis , chest pain , aorta , radiology , cardiology
Background: Ascending aortic pseudoaneurysms following prior cardiac procedures are a rare entity. We reviewed our institutional experience given the isolated case reports in the literature. Methods: A 10‐year retrospective review identified 5 patients who underwent ascending aorta pseudoaneurysm repair. There were 3 women and 2 men with a median age of 70 years (range 63 to 79 years). Median duration from initial CABG to pseudoaneurysm repair was 5 years (range 5 months to 18 years). The clinical presentations included dyspnoea (2 patients), chest pain, fever of unknown origin, and a pulsatile mass. Four patients underwent urgent investigation and surgery. Diagnosis was established via CT scan (3 patients), transesophageal echocardiogram (1 patient), and MRA (1 patient). Two patients had a prior history of sternal wound infection. Results: Mortality was 60%. One survivor experienced a stroke. The etiology was prior cannulation site in 4 cases and vein graft anastamotic site in 1. Necrotic aortic tissue was noticed in 2 cases. Aortic tissue cultures were negative in all the patients. Cardiopulmonary bypass was established prior to sternotomy in 4 cases and 1 case was performed off‐pump. Inadvertent rupture of the pseudoaneurysm (without exsanguination) occurred in 2 cases following sternotomy. Repair was performed with bovine pericardial patch in 2 cases and plication in 3 cases. Conclusion: This highlights the varied presentation, necessity for urgent diagnosis and repair with a high operative mortality due to the late presentation. Aggressive diagnosis should be sought and consideration should be given to catheter‐based interventions for initial treatment.