Author + information
- Received April 26, 2016
- Accepted May 5, 2016
- Published online August 22, 2016.
- aDepartment of Cardiovascular Surgery, People's Hospital of Guizhou Province, Guiyang, China
- bDepartment of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- ↵∗Reprint requests and correspondence:
Dr. Kui Hu, Department of Cardiovascular Surgery, People's Hospital of Guizhou Province, 83 Eastern Zhongshan Road, Guiyang 550002, People’s Republic of China.
A previously healthy 37-year-old man presented with chest pain for 2 weeks. He did not have hypertension or any other pertinent medical condition, and did not have trauma or surgical history. Chest radiograph showed giant shadow in the right thoracic cavity (Figure 1). Transthoracic echocardiography demonstrated giant pseudoaneurysm in ascending aorta. Contrast-enhanced computed tomography confirmed the giant ascending aortic pseudoaneurysm with diameter of 141 mm × 102 mm (Figure 2A, Online Videos 1 and 2) and its breach was about 5 mm upper the ostium of left coronary artery (Figure 2B), and the right lung as well as right atrium was seriously pressed (Figures 2A and 2B).
We failed to repair the breach with patch or do supercoronary aorta replacement due to extensive calcification of the aortic wall around the breach (Figure 3A). At last, we successfully closed the breach with a 16 mm patent ductus arteriosus occluder (WBFDQ-I, SHSMA, China) (Figure 3B). We interruptedly sutured the occlude device to the aortic wall where it was not calcified to reinforce it.
Computed tomography on the sixth day (Figures 4A and 4B) and in the fifth month post-operatively (Figures 4C and 4D) confirmed correct positioned occluder and absence of endoleak as well as well re-expansion of the right lung. The patient was asymptomatic and enjoyed a good life during the follow-up.
Pseudoaneurysm rarely occurs in patients without hypertension or history of trauma or surgical procedures. In our case, the young, previously healthy man was deemed not high risk for surgery and open surgical repair was the first choice. However, surgical repair failed due to the extensive calcification of the aortic wall around the breach. Our results suggest that occluder closure is safe and effective for the treatment of chronic spontaneous pseudoaneurysm.
The authors thank Dr. Rong-Pin Wang for help with images.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2016.
- Accepted May 5, 2016.
- American College of Cardiology Foundation