Pseudoaneurysms of the Ascending Aorta Following Coronary Artery Bypass Surgery

• Published in: Journal of cardiac surgery Vol. 21; no. 3; pp. 221 - 224
• Main Authors: Dhadwal, Ajay K., Abrol, Sunil, Zisbrod, Zvi, Cunningham Jr, Joseph N.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-05-2006
• Subjects: Aged; Aneurysm, False - diagnosis; Aneurysm, False - etiology; Aneurysm, False - surgery; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - etiology; Aortic Aneurysm, Thoracic - surgery; Coronary Artery Bypass - adverse effects; Diagnosis, Differential; Echocardiography, Transesophageal; Female; Follow-Up Studies; Humans; Magnetic Resonance Angiography; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Survival Rate; Tomography, X-Ray Computed
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1111/j.1540-8191.2006.00220.x

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.