Giant aorta pseudoaneurysm repair. Ramon Aranda.mp4 (455.55 MB)
Giant Ascending Aorta Pseudoaneurysm Repair Under DHCA and ACP: A Surgical Case Report With Anatomical and CT/TEE Correlation
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posted on 2021-02-23, 22:08 authored by Ramón Aranda, Sergio Cánovas, José María Arribas, Antonio Jimenez-Aceituna, Juan M. Aguilar, Joaquin Pérez-Andreu, José Antonio Moreno, Francisco GutierrezAortic ascending pseudoaneurysm (AAP) is a rare and challenging
pathology whose understanding could be demanding for cardiothoracic
residents. Video reports of this condition are scarce and the
correlation between the surgical findings and the preoperative
diagnostic images are often not performed.
The authors present a clinical case which focuses on the correlation
between anatomy and CT/TEE findings as well as perfusion and brain
protection strategy. Regarding AAP etiology, previous cardiac surgery is
often associated and traumatic, and infectious events could also be
present. Aortic root procedures are the most commonly associated
procedures, accounting for 55% of cases in a retrospective study of a
series of patients published in 2010 (1). In the same way, a recent
systematic review concludes that AAPs are almost always associated with a
history of aortic surgery (2). Clinical presentation of postoperative
AAP usually occurred within two years of the initial operation with an
incidence of 0.5% according to another report (3). Surgical repair
remains the standard treatment for this kind of patient, whereas
endovascular therapies (mainly occlusion devices) have been reported and
could be useful in high-risk patients (2). Surgical repair usually
requires circulatory arrest, brain protection, and peripheral
cannulation in order to achieve an optimal exposure of the AAP and
prevent cardiac injury during thorax opening. The authors conducted an
allograft replacement of the ascending aorta with DHCA and bilateral
antegrade cerebral perfusion during this clinical case. Perfusion and
brain protection strategies were focused in this video with educational
purposes.
References
- Malvindi PG, van Putte BP, Heijmen RH, Schepens MA, Morshuis WJ. Reoperations for aortic false aneurysms after cardiac surgery. Ann Thorac Surg. 2010 Nov;90(5): 1437-1443.
- Quevedo
HC, Santiago-Trinidad R, Castellanos J, Atianzar K, Anwar A, Abi Rafeh
N. Systematic review of interventions to repair ascending aortic
pseudoaneurysms. Ochsner J. 2014; 14: 576-585.
- Atik FA, Navia JL, Svensson LG, Vega PR, Feng J, Brizzio ME, et al. Surgical treatment of pseudoaneurysm of the thoracic aorta. J Thorac Cardiovasc Surg. 2006 Aug;132(2):379-385.