Ascending aortic pseudoaneurysms are rare entities that can occur after trauma,infection, connective tissue disorders, vasculitis or as a complication of cardiac surgery.They occur in less than 0.5% of cardiac surgical cases. The mean discovery time of the aneurysm after initial surgery is 22 months but it can last for decades.They can be presented with a large scale of clinical symptoms.Diagnosis can be meade with chest computed tomography scan, magnetic resonance imaging, aortography, transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE).
We present a 61 years old male patient who had a aortic valve replacement and tricuspit de vega annuloplasty 2 years ago. The patient is discharged after a uneventfull period of 6 days after the operation. In his first postoperative year a TTE showed a sinus valsalva aneurysm of 53 mm. The patient had no complaints. 28 months after the operation a routine control ecocardigraphy showed a sinus valsalva aneurysm of 66 mm with a intimal flep. A computed tomography angiography is performed. Surgery for ascendan aortic replacement is performed. After carefully exposure cardiopulmanary bypass is initiated. The aortotomy is made and a 4 cm long transverse – oblic tear in the posterior aortic wall is explored. There was no flap of dissection it was the opening of a chronic pseudoaneurysm of the aorta. The psudoaneurysms wall was formed of the pericardium posterior to aorta. The tear in the aortic wall was beginning 8 mm distal to the left coronary artery orifice and continued mildly to a cranial position. The 4 cm long tear is sewn primarly with a dacron felt. We begun to suture a 32 mm dacron graft to a supracoronary position.The posterior suture line is placed over the dacron felt and the proksimal anastomosis is completed. After the end of the ascending aortic replacement the patient is taken to the intensive care unit, his postoperative period was uneventfull.
The development of our patients pseudoaneurysm is not clear.. The scar tissue that surrounded the aorta has limited a rupture and formed a growing pseudoaneurysm on the posterior aortic wall. He had no symptoms or complaints. We think it can be related to the previous surgery.It firstly was diagnosed as a aortic dissection in a routine control. We conclude that patients with prevous cardiac surgery must be followed up closely and atypiccal foundings must be evaluated further.
