Percutaneous closure of a post-surgical ascending aortic pseudoaneurysm with an amplatzer septal occluder device and steerable guiding sheath

Thoracic pseudoaneurysm in the ascending aorta is an uncommon condition associated with significant risk of morbidity and mortality. Treatment is recommended in all cases regardless of symptoms as the mortality rate if left untreated has been documented to be as high as 61%. The current standard of care for managing these lesions is open surgical repair. However, this is associated with significant morbidity. In-hospital mortality reported for patients undergoing surgical repair of an ascending aortic pseudoaneurysm ranges from 6.7% to 41%. When anatomically suitable, a less invasive approach using amplatzer vascular plug or septal occluder is an attractive approach. We present a case report of repair of a post-surgical ascending aortic false aneurysm using an amplatzer septal occluder with an Oscor ™ steerable guiding sheath; a novel approach to increase platform stability when engaging an aneurysm neck. Endovascular occluder deployment for closure of aortic false aneurysms remains a relatively novel technique. It is limited by the requirement to develop a stable endovascular platform to deliver the device and avoid system prolapse, particularly when accessing challenging lesions on the inner aortic curvature. We present the first case to utilize a steerable guiding sheath system to improve system stability and facilitate successful device delivery. Given the significant morbidity associated with open repair of these lesions we hope this will further expand the range of lesions viewed as appropriate for endovascular repair.     

Significance of symptoms and signs in patients with traumatic aortic rupture

The records of 50 patients with traumatic aortic rupture (Group I) and 50 patients with blunt chest trauma but negative aortograms (Group II) were reviewed retrospectively. Symptoms and signs referable to the chest and thoracic aorta were recorded and compared in Group I and Group II patients. Each patient's chart was evaluated for chest pain, respiratory distress, thoracic back pain, hypotension, hypertension, and decreased femoral pulses. None of the symptoms or signs attained statistical significance between Group I and Group II patients. The only significant difference between Group I and Group II patients was in the injury severity score (ISS). The mean ISS for aortic rupture patients was 42.1 +/- 11.6 (SD), but was only 19.9 +/- 11.4 (SD) (P less than .001) for patients without aortic rupture. We conclude that the diagnosis of aortic rupture in patients sustaining blunt chest trauma cannot be accurately predicted or excluded on the basis of the patients' presenting complaints or physical findings.     

Embolization of an amplatzer mVSD occluder device used for percutaneous closure of an ascending aortic pseudoaneurysm: Case report and literature review

Pseudoaneurysm of the ascending aorta is a rare, but potentially dangerous condition. The high morbidity and mortality rate associated with its surgical management has led to the development of transcatheter approaches. We report a case of percutaneous closure of an ascending aortic pseudoaneurysm using an Amplatzer mVSD occluder device complicated by device embolization at day 27 and we review the literature of Amplatzer devices in this off‐label use. © 2011 Wiley Periodicals, Inc.     

Transesophageal Echocardiographic Diagnosis of Aortic Graft Dehiscense at Coronary Anastomoses and Pseudonaneurysm Rupture into Right Atrium

We describe a case of aortic graft dehiscence at coronary anastomoses with rupture into the right atrium of the pseudoaneurysm complicating aortic graft replacement. These were diagnosed by intraoperative transesophageal echocardiography.     

Percutaneous closure of ascending aortic pseudoaneurysm using Amplatzer septal occluder device: the first clinical case report and literature review.

We report the first case of the use of an Amplatzer septal occluder device to close a large ascending aortic pseudoaneurysm. The patient had a complex cardiac history with redo coronary artery bypass graft surgery, severe left ventricular dysfunction, and end-stage renal disease requiring hemodialysis. The procedure was successfully performed under fluoroscopic and 2D/3D transthoracic echocardiographic guidance. Six-week follow-up with both transthoracic echocardiography and MRI showed the device was in proper position with complete closure of the pseudoaneurysm.     

Endovascular treatment of thoracic aortic disease: mid-term follow-up.

OBJECTIVE: The aim of this study was to evaluate the mid-term follow-up in a cohort of patients with acute or chronic descending aortic disease treated by stent-graft repair. BACKGROUND: Since 1999, endovascular stent-graft placement has been reported as an alternative treatment to surgical approach for a variety of thoracic aortic diseases; however, results beyond initial short-term follow-up are not widely available for the broad range of applications. METHODS: From March 2001, 43 consecutive patients with traumatic aortic transection (group A = 16) and complicated type B aortic dissection or aneurysm (group B = 27) underwent stent-graft implantation. All patients underwent computed tomography (CT) scan as preoperative assessment and in 26 a transesophageal echo (TEE) exam was performed. RESULTS: Technically successful stent-graft deployment was achieved in all patients. No patient required surgical conversion and no cases of paraplegia occurred. The overall in-hospital mortality was 9.3%. A residual endoleak (type II) was detected in one group B patient who was managed conservatively. The mean follow-up was 29 +/- 8 months (range 10-48 months). No patient died during late follow-up after hospital discharge. At 12 months, one patient (2.5%) who had stent graft repair of an aortic dissection developed an asymptomatic type I endoleak. Three asymptomatic patients with chronic dissection had a persistent retrograde perfusion of the thoracic false lumen via a distal tear(s) in the dissection septum. CONCLUSION: Our results of stent-graft treatment of complicated and uncomplicated diseases of the descending aorta confirms that this alternative to open repair is a safe, less invasive, and relatively low risk approach. Medium-term follow-up results suggest that it is effective and durable therapy with low associated mortality and morbidity rates.     

Pseudoaneurysm—a Treatable Form of Cardiac Rupture

Abstract. Pseudoaneurysm is an unusual complication of myocardial infarction. Although its pathogenesis is known, the course of the condition is obscure. The diagnosis is usually made post-mortally. We present a case of a pseudoaneurysm following a myocardial infarction, diagnosed at a routine policlinical echocardiographic examination in a patient who at the time of diagnosis was free of symptoms. The patient was successfully operated upon.     

Post-traumatic pseudoaneurysm of the common hepatic artery with duodenal fistula

BackgroundPost-traumatic pseudoaneurysm of the hepatic artery is rare, especially after blunt abdominal trauma; an even more rare occurrence is enteric fistulisation.Case outlineA 29-year-old man was admitted with an acute episode of upper gastrointestinal bleeding three months after blunt abdominal trauma and was found to have an hepatic artery pseudoaneurysm with duodenal fistula. Surgical treatment was by ligature of the artery and duodenal closure with omental patch.DiscussionThere is one previous case report of hepatic artery pseudoaneurysm as a delayed complication of blunt abdominal trauma. The presence of a haematoma in the hepatoduodenal ligament after blunt trauma should raise the suspicion of hepatic artery injury, and surgical exploration may prevent the subsequent development of pseudoaneurysm. CT scan has become an important instrument both in diagnosis and in surgical planning.     

Percutaneous treatment of late‐aortic pseudoaneurysm resulting from surgical repair of aortic coarctation

We describe the case of a 38‐year‐old woman who presented with symptoms of chest pain and shortness of breath that had worsened over the previous 6 months and was found to have a large pseudoaneurysm (PSA) of the thoracic aorta. She underwent surgical repair of aortic coarctation at the age of 16 and a revision of her bypass graft at age 28 when she presented with hemoptysis due to aortic PSA and aortobronchial fistula. Our cardiothoracic surgical team deemed a third surgery very high risk; therefore, she was referred to us for percutaneous repair of aortic PSA. We describe the successful treatment of the PSA using a technique of microcoil embolization and Amplatzer® vascular plug (AGA Medical Corp., Plymouth, MN).© 2011 Wiley‐Liss, Inc.     

Dissecting intramyocardial hematoma masquerading as a pseudoaneurysm of left ventricular free wall: an unusual case of myocardial rupture.

This report presents a case of left ventricular intramyocardial dissection masquerading as a ventricular pseudoaneurysm. Only serial echocardiograms could lead to the correct diagnosis, and left ventricular angiography could appropriately direct further testing and treatment.     

Multimodality imaging evaluation of a mitro‐aortic fibrosa pseudoaneurysm fistulizing into both atria

To our knowledge, we describe the first case of a pseudoaneurysm of the mitro‐aortic intervalvular fibrosa fistulizing into both atria, following an aortic bacterial endocarditis and valve replacement.     

Transesophageal echocardiographic diagnosis of traumatic rupture of the noncoronary cusp of the aortic valve

We report a patient with traumatic aortic valve injury in whom a large defect in the noncoronary cusp of the aortic valve was clearly visualized by multiplane TEE and confirmed at surgery.     

Nonneoplastic diseases of aorta and pulmonary trunk—Part III

This five-part review focuses on selected nonneoplastic diseases of the aorta and pulmonary trunk. Because many more diseases affect the aorta compared with the pulmonary trunk and right and left main pulmonary arteries, most of this review will be devoted to disorders of the aorta. Part III of this five-part series discusses the etiology of aortic aneurysms and aortitis.     

A rare echocardiographic image of aortic prosthetic valve endocarditis complicated with paravalvular abscess,pseudoaneurysm and aorto‐right atrial fistula

Early infectious endocarditis (IE) occurs in 3% of prosthesis in the first 12 months. Early IE is more aggressive than late prosthetic valve endocarditis. Mortality remains high, despite combined medical and surgical treatment. We present a case of early IE in aortic prosthetic valve complicated with paravalvular abscess, pseudoaneurysm and aorto‐ right atrial fistula.     

Systematic review of the evaluation and management of coronary pseudoaneurysm after stent implantation

Pseudoaneurysm (PSA) formation is a rare but well-known complication of coronary stenting. It develops after a procedural perforation disrupts the integrity of the vessel wall but is contained by a single wall layer, usually pericardium, extravascular thrombosis and later fibrosis. Medical literature of PSA consists primarily of case reports. A systematic review of pseudoaneurysm after coronary stenting was performed to summarize its presentation, diagnostic imaging modalities, natural history, and management approaches. Clinical presentations range from asymptomatic to hemodynamic collapse, size from small to “giant,” and treatment approaches from surgical or percutaneous exclusion to “watchful waiting” and imaging surveillance. Based on current information, a management algorithm is provided recommending urgent to emergent exclusion for symptomatic PSA, elective exclusion for large and giant PSA, and “watchful waiting” and periodic imaging surveillance for small to moderate sized PSA.