Endovascular Repair of a Pseudoaneurysm After Multiple Open Repairs of Aortic Coarctation.

Successful surgical repair of aortic coarctation during childhood may have major late complications such as pseudoaneurysm formation. If left untreated, pseudoaneuryms put patients at risk for morbidity and death; if treated surgically, they are associated with complications. Endovascular aortic repair, an established safe alternative to open surgical repair, is associated with encouraging outcomes and fewer complications, and it is especially feasible for patients who have undergone multiple aortic surgeries. We report the case of a 41-year-old man who underwent endovascular repair of a pseudoaneurysm after previous surgical corrections of an aortic coarctation at 6 and 14 years of age. The pseudoaneurysm, involving the distal portion of an ascending-to-descending aortic 20-mm Dacron bypass graft, was successfully excluded with a thoracic stent-graft and sealed off with vascular plugs to prevent both blood flow into the pseudoaneurysm and type II endoleak.

Proximal Descending Thoracic Aortic Pseudoaneurysm in a 24-Year-Old Man after 2 Childhood Repairs of Interrupted Aortic Arch.

Improved management of interrupted aortic arch has increased long-term survival rates. Longer life expectancies in neonates and children surgically treated for interrupted aortic arch may necessitate complex reinterventions when sequelae develop in adulthood. We report the case of a 24-year-old man who had undergone initial repair of interrupted aortic arch type B at one week and reintervention at 6 years of age. He presented with a 5.5 × 9-cm pseudoaneurysm of the proximal descending thoracic aorta. He underwent surgical replacement of his distal aortic arch and proximal descending thoracic aorta, with a bypass to his left subclavian artery. In addition to our patient's case, we discuss considerations in treating recipients of early interrupted aortic arch repairs as they live longer and undergo multiple reinterventions.

Left Transthoracic Approach for Magnetic Sphincter Augmentation Device LINX Implantation.

Magnetic sphincter augmentation with the LINX Reflux Management System (Torax Medical, St. Paul, MN) is a recently introduced surgical option with comparable therapeutic efficacy for medically refractory gastroesophageal reflux disease. An appropriately sized LINX device is usually placed around the gastroesophageal junction through a laparoscopic approach. In general, redo abdominal surgeries are technically challenging, with a higher risk of associated morbidity. This highlights the need to obtain feasible alternative access to place the LINX device for certain patient populations. In this case series, we described 2 patients who underwent LINX device implantation through left thoracotomy because of previous abdominal surgeries that prohibited a transabdominal approach.

Successful Conservative Management of a Large Splenic Abscess Secondary to Infective Endocarditis.

The spleen is the most common abdominal site for systemic septic emboli that often complicate infective endocarditis. Management of an embolic splenic abscess usually involves surgical splenectomy or image-guided drainage, but the natural history of splenic abscess without drainage is unknown. We describe the successful conservative treatment of a large complex splenic abscess with antibiotics alone in a patient with aortic valve infective endocarditis who required an emergent valve replacement surgical procedure. Previous complex abdominal wall operation with the presence of a synthetic mesh made abdominal surgical intervention unfavorable. The splenic abscess resolved completely with no recurrence of infection at the 3-year follow-up.