open access

Vol 24, No 1-2 (2022)
Case report
Published online: 2023-06-27
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Aortic pseudoaneurysm in a patient after Bentall de Bono surgery

Michał Wysocki1, Weronika Biziorek1, Łukasz Moskal1, Katarzyna Wijatkowska1, Wojciech Kustrzycki1, Romuald Cichoń1
·
Chirurgia Polska 2022;24(1-2):36-39.
Affiliations
  1. Department of Cardiac Surgery, Medinet Heart Center Ltd, Wroclaw, Poland (Oddział Kardiochirurgii, Dolnośląskie Centrum Chorób Serca im. Prof. Zbigniewa Religi MEDINET Sp. z o.o., Wrocław)

open access

Vol 24, No 1-2 (2022)
Case reports
Published online: 2023-06-27

Abstract

Pseudoaneurysm is an aneurysm arising as a result of rupture with all layers of the artery wall. It differs from the true aneurysm in the wall structure, aetiology, complications and indications for invasive treatment. Postoperative pseudoaneurysms of the thoracic aorta are rare complications, but extremely dangerous and life-threatening. Therefore, it is important to keep in mind crucial factors that can lead to its appearance. The method of treatment depends on localization with median sternotomy in the surgical approach to a pseudoaneurysm of the ascending aorta. Most frequently surgeons excise the aneurysm and sew appropriate prosthesis in the place of the excision. As a result, the Bentall de Bono procedure is widely used, when the aortic root replacement is required. This study presents a case of a 59-year-old man with a huge pseudoaneurysm of the ascending aorta 3.5 months after the Bentall de Bono operation. The patient’s treatment included resternotomy with the use of a similar technique once again. EuroScore II was high and amounted to 21.94%. Additionally, hypothermia was used to increase the effectiveness of the procedure, i.e. to minimalize blood loss, protect the central nervous system from the risk of ischaemia and facilitate the patient’s recovery. Pseudoaneurysm can develop for years without any symptoms, and its rupture can be fatal. Finally, detection and removal of the lesion at the beginning of its formation has a positive impact on the patient’s prognosis.

Abstract

Pseudoaneurysm is an aneurysm arising as a result of rupture with all layers of the artery wall. It differs from the true aneurysm in the wall structure, aetiology, complications and indications for invasive treatment. Postoperative pseudoaneurysms of the thoracic aorta are rare complications, but extremely dangerous and life-threatening. Therefore, it is important to keep in mind crucial factors that can lead to its appearance. The method of treatment depends on localization with median sternotomy in the surgical approach to a pseudoaneurysm of the ascending aorta. Most frequently surgeons excise the aneurysm and sew appropriate prosthesis in the place of the excision. As a result, the Bentall de Bono procedure is widely used, when the aortic root replacement is required. This study presents a case of a 59-year-old man with a huge pseudoaneurysm of the ascending aorta 3.5 months after the Bentall de Bono operation. The patient’s treatment included resternotomy with the use of a similar technique once again. EuroScore II was high and amounted to 21.94%. Additionally, hypothermia was used to increase the effectiveness of the procedure, i.e. to minimalize blood loss, protect the central nervous system from the risk of ischaemia and facilitate the patient’s recovery. Pseudoaneurysm can develop for years without any symptoms, and its rupture can be fatal. Finally, detection and removal of the lesion at the beginning of its formation has a positive impact on the patient’s prognosis.

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Keywords

pseudoaneurysm; aortic operation; aortic root, surgery; Bentall de Bono; invasive treatment; reoperation

About this article
Title

Aortic pseudoaneurysm in a patient after Bentall de Bono surgery

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 24, No 1-2 (2022)

Article type

Case report

Pages

36-39

Published online

2023-06-27

Page views

802

Article views/downloads

140

DOI

10.5603/ChP.2022.0004

Bibliographic record

Chirurgia Polska 2022;24(1-2):36-39.

Keywords

pseudoaneurysm
aortic operation
aortic root
surgery
Bentall de Bono
invasive treatment
reoperation

Authors

Michał Wysocki
Weronika Biziorek
Łukasz Moskal
Katarzyna Wijatkowska
Wojciech Kustrzycki
Romuald Cichoń

References (9)
  1. Katsumata T, Moorjani N, Vaccari G, et al. Mediastinal false aneurysm after thoracic aortic surgery. Ann Thorac Surg. 2000; 70(2): 547–552.
  2. Wojciech Noszczyk: Chirurgia repetytorium. Warszawa: PZWL, 2009. ISBN 978-83-200-3843-9.
  3. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. European Heart Journal. 2014; 35(41): 2873–2926.
  4. Madia C. Management trends for postcatheterization femoral artery pseudoaneurysms. JAAPA. 2019; 32(6): 15–18.
  5. Atik FA, Navia JL, Svensson LG, et al. Surgical treatment of pseudoaneurysm of the thoracic aorta. J Thorac Cardiovasc Surg. 2006; 132(2): 379–385.
  6. Mookhoek A, Korteland NM, Arabkhani B, et al. Bentall Procedure: A Systematic Review and Meta-Analysis. Ann Thorac Surg. 2016; 101(5): 1684–1689.
  7. Mutsuga M, Narita Y, Usui A. Mid-term results of Biological Bentall using a larger valve implantation technique. Nagoya J Med Sci. 2020; 82(4): 645–655.
  8. Zivkovic I, Stankovic S, Krasic S, et al. Surgical Treatment of Pseudoaneurysm of the Ascending Aorta in a Patient with Sepsis. Braz J Cardiovasc Surg. 2021; 36(2): 261–264.
  9. Parihar B, Choudhary LSD, Madhu AP, et al. Pseudoaneurysm of ascending aorta after aortic valve replacement. Ann Thorac Surg. 2005; 79(2): 705–707.

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