Pseudoaneurysm of the ascending aorta is a rare complication (<1%) that may occur after cardiac surgery procedures but can be a life-threatening complication. Often, ascending aortic pseudoaneurysm is asymptomatic but in some cases symptoms and clinical presentation could be unclear. This leads to misdiagnosis and delay in the prompt surgical approach [1–4].
A case of a 22-year-old man with asymptomatic aortic double chambers pseudoaneurysm that infiltrate the sternum. Patient is African and he has been disembarked at Lampedusa Island illegally. At the first health control in the “Policy Department”, the physician relieved a systolic murmur (Levine 2/6) and detected the presence of a mechanical prosthetic valve in aortic position. Patient had undergone aortic valve replacement 6 years ago. He reached our institution in a good clinical condition. A partially calcified ascending aortic pseudoaneurysm and a right atrium-left ventricle fistula (AVF) just below the aortic valve were detected by cardiac ultrasound. ECG-gated 64-slice Multidetector Computed Tomography Angiography (Brilliance 64, Philips Medical Systems, Cleveland, Ohio) of the entire thorax was performed to assess the coronary tree (Fig. 1), and identified the extension and the relationship of the giant pseudoaneurysm with the other neighbouring structures (Figs. 2 and 3). An infiltration of the sternum for about 7 mm was detected (thick arrows in Figs. 2 and 3). The presence of the AVF was confirmed and its extension to the right atrium was observed as well (thin arrows in Fig. 3). Patient underwent surgical resection of the pseudoaneurysm (Fig. 4) and replacement of the ascending aorta using a Dacron graft (arrowheads in Fig. 4) under deep hypothermia circulatory arrest that was performed before sternotomy to avoid the risk of pseudoaneurysm rupture.
Roberts WC: Complications of cardiac valve replacement: characteristic abnormalities of prostheses pertaining to any or specific site. Am Heart J. Jan 1982; 103(1): 113–122.
Albat B, Leclercq PF, MessnerPellenc P, Missov E, Thevenet P: False aneurysm of the ascending aorta following aortic valve replacement. J Heart Valve Dis. Mar 1994; 3(2): 216–219.
Sullivan KL, Steiner RM, Smullens SN, Griska L, Meister SG: Pseudoaneurysm of the ascending aorta following cardiac surgery. Chest Jan 1988; 93(1): 138–143.
Kirklin J, Barratt-Boyes B: Cardiac surgery: morphology, diagnostic criteria, natural history, techniques, results, and indications. 2nd ed.: Churchill Livingstone, New York, 1993, pp. 491–571.