A Case of Redo Ascending Aortic Replacement for Anastomotic Pseudoaneurysm through Right Thoracotomy in a Patient with Severe Coagulation Disorder / 日本心臓血管外科学会雑誌

A 51-year-old man presented to our hospital with general fatigue and lower extremity edema due to right heart failure with severe coagulation disorder. He had undergone ascending aortic and total arch replacement for type A acute aortic dissection when he was 49 years old and had diagnosed with anastomotic pseudoaneurysm in the ascending aorta by computed tomography 1 year after the operation. Preoperative computed tomography showed an enlargement of the pseudoaneurysm. Since re-median sternotomy seemed to be high risk strategy for bleeding due to severe coagulation disorder, we decided to perform ascending aortic replacement through right thoracotomy. We opened the pseudoaneurysm and found an aorto-right atrium fistula. Redo ascending aortic replacement with direct closure of the fistula was successfully performed. The postoperative course was uneventful.

Hybrid Repair for an Anastomotic Pseudoaneurysm of the Bicarotid Trunk / 日本心臓血管外科学会雑誌

Herein, we report a rare case of a pseudoaneurysm at the anastomotic site of the bicarotid trunk after thoracic aortic graft replacement. A 53-year-old man with Marfan syndrome underwent a three-stage operation involving aortic root reimplantation and ascending aortic replacement ; aortic valve replacement and total arch replacement ; and descending aortic replacement performed for type A dissection combined with an aberrant right subclavian artery. Two years after total arch replacement, the patient presented with hoarseness and a computed tomography scan revealed an anastomotic pseudoaneurysm of the common trunk of the left and right carotid arteries. A right axillary artery-common carotid artery bypass was performed, with simultaneous insertion of a vascular stent graft from the left common carotid artery to the anastomotic site. Cervical bypass and stent implantation were both performed without shunting. He was discharged home without any neurological complications.

Successful Reoperation for Anastomotic Pseudoaneurysm Fistulation into the Right Pulmonary Artery / 日本心臓血管外科学会雑誌

A 71-year-old man presented to our hospital with sudden-onset epigastric pain. He reported a history of undergoing the following operations : aortic valve replacement for aortic regurgitation 11 years earlier and graft replacement of the ascending aorta for acute type A aortic dissection, 1 year earlier. His systolic blood pressure was 70 mmHg, and computed tomography revealed a pseudoaneurysm of the distal anastomosis of the ascending aorta with a connection to the right pulmonary artery. Cardiopulmonary bypass was established with cannulation of the right axillary artery and the right femoral vein, and systemic cooling was initiated before sternotomy. We identified an area showing 3 cm dehiscence at the distal aortic anastomosis after hypothermic circulatory arrest and selective cerebral perfusion. The ascending aorta was replaced as hemiarch replacement, and the defect in the right pulmonary artery was closed with bovine pericardium. The patient's postoperative course was uneventful, and he was transferred to a rehabilitation hospital on the 22nd postoperative day.

A Case of Total Arch Replacement for Non-anastomotic Pseudoaneurysm by Proximal Stent Graft Induced-Vascular Graft Perforation in Loeys-Dietz Syndrome after Total Aortic Replacement / 日本心臓血管外科学会雑誌

A 26-year-old lady with Loeys Dietz syndrome had undergone 5 consecutive operations from 2007 to 2014. Finally, her total aorta was replaced by vascular grafts and stent grafts. The patient was admitted to our hospital with headache and dizziness in 2016. Computed tomography showed a giant pseudoaneurysm at the aortic arch with extravasation from the vascular graft. The proximal flares of thoracic stent grafts caused perforation of thoracic vascular grafts. Cerebral perfusion was not sufficient, because this aneurysm compressed the innominate, left carotid and left subclavian arteries. Decreasing of cerebral perfusion caused headache and dizziness. We performed total arch replacement. We started extracorporeal circulation before median sternotomy but the aneurysm ruptured during median sternotomy. We controlled the bleeding by manual compression and immediately started selective cerebral perfusion and induced cardiac arrest. After opening the distal portion, we cut down the proximal flares of thoracic stent graft and inserted an elephant trunk into the stent graft. We sutured between the new vascular graft and the stent graft and covered the suture line with another short vascular graft. As a result we could protect the vascular graft from the stent graft. Computed tomography demonstrated that the pseudoaneurysm and extravasation disappeared. Cerebral perfusion increased and the patient's symptoms improved. Postoperatively the patient was discharged from our hospital without any major complications at POD 11.

A Case of Endovascular Aortic Repair with a Vascular Embolic Device and Stent-Graft for the Anastomotic Pseudoaneurysm in the Ascending Aorta / 日本心臓血管外科学会雑誌

<p>We report a case of a 72-year-old woman, who had an anastomotic pseudoaneurysm in the ascending aorta, successfully treated by endovascular aortic repair with vascular embolic devise and stent-graft. It seemed to be high risk to achieve conventional surgery with extracorporeal circulation, therefore we selected endovascular treatment because she had a bleeding tendency which derived from disseminated intravascular coagulation. Then, we adopted stent-grafting with a vascular embolic device, because the distal side of pseudoaneurysm had too short a landing zone to cover the stent-graft only. The patient well tolerated this procedure and her postoperative course was uneventful. The pseudoaneurysm shrank at 6th months after operation.</p>