Conference abstract
Surgical repair of a giant aortic pseudo-aneurysm in a patient with previous double valve replacement: a case report
Pan African Medical Journal - Conference Proceedings. 2023:17(80).04
Jun 2023.
doi: 10.11604/pamj-cp.2023.17.80.1840
Archived on: 04 Jun 2023
Contact the corresponding author
Keywords: Aortic pseudoaneurysm, redo cardiac surgery, sub-Saharan Africa
Poster
Surgical repair of a giant aortic pseudo-aneurysm in a patient with previous double valve replacement: a case report
Mve Mvondo Charles1,2,3,&, Ngo Yon Laurence Carole2,3,4, Tsague Kengni Hermann Nestor2,3, Kobe Fokalbo Zephanie3, Ngowe Ngowe Marcelin2
1St Elizabeth Catholic General Hospital Shisong, Cardiac Centre Shisong, Kumbo, Cameroon, 2Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon, 3Division of Cardiovascular Surgery, Yaoundé General Hospital, Yaoundé, Cameroon, 4National Social Insurance Fund Hospital, Yaoundé, Cameroon
&Corresponding author
Introduction: aortic pseudo-aneurysm (AP) is a rare and fearful complication that might occur following heart surgery with rates ranging between 0.5% and 8.5% in several series. It can occur in a variable period of time, from a few days to several years after surgery. AP has been associated to graft and surgical site infections, trauma, degenerative disease and surgical site leaks. Surgical repair remains the mainstay of therapy although associated with high mortality rates varying between 6.7% and 46% in several reports. Although endovascular repair has gained major attention in recent years as an alternative to conventional surgery in the treatment of AP, it is not always feasible or available as it’s the case in many developing countries.
We report the case of a 37-year-old sub-Saharan African female who underwent surgical repair for a giant retro-sternal pseudoaneurysm of the ascending aorta nine months after a double mechanical replacement and aortic root enlargement procedure.
Case presentation: a 37-year-old female with past history of double mechanical replacement and aortic root enlargement 9 months earlier was referred to our unit for a progressive, pulsatile and compressive discomfort in the back sternum for 2 weeks. She also complained of mild fatigue and sporadic episodes of chest pain in the left hemithorax with no dyspnea or palpitations.
The postoperative course at prior surgery was characterized by mild fever and superficial sternal wound dehiscence that was treated with oral antibiotics and wound medication for two weeks followed by complete healing. Transthoracic echocardiography at admission showed a good function of the previously implanted prosthetic valves with a mild reduction of left ventricular contractility (45%). A huge para-aortic cavity (9 x 10 cm) communicating with the aortic root was found in the left parasternal view, located in the anterior-right lateral segment of the ascending aorta. A subsequent Computed Tomography Angiography scan revealed a giant aortic pseudoaneurysm communicating to the aortic root. Considering the potential life-threatening evolution of the lesion, a consensual decision was taken with the patient and relatives for a surgical repair which was planned in an elective setting.
Cardiopulmonary bypass (CPB) was established by direct cannulation of the right axillary artery and the right femoral vein, and the patient was progressively cooled to 22°C. After exposure of the sternal bone, the patient was positioned in deep trendelenburg position and the CPB was interrupted. Sternal re-entry was then performed under a short deep hypothermic circulatory arrest. A fast exposure of the distal ascending aorta was achieved, and a cross-clamp was applied. CPB was then restarted with progressive systemic rewarming through the right axillary artery. After the removal of periaortic thrombi, an aortic tear was found on the previous aortic suture line for patch enlargement. An aortotomy was done and cardioplegia was delivered selectively in the coronary ostia. The aortic root and ascending aorta were meticulously inspected to rule out other lesions and the aortotomy closed with a new heterologous pericardial patch with continuous sutures reinforced with multiple interrupted pledgeted single sutures.
The patient was transferred to the intensive care unit and weaned from mechanical ventilation 5 hours after surgery. Postoperative echocardiograms showed no evidence of residual lesions in the aortic root and good function of both mechanical valves. The global postoperative course was uneventful, and the patient was discharged on the postoperative day 7th. A control Computed Tomography Angiography performed one month after discharge showed good surgical result with complete restoration of the aortic lumen.
Surgical repair of a giant aortic pseudo-aneurysm in a patient with previous double valve replacement: a case report
Mve Mvondo Charles1,2,3,&, Ngo Yon Laurence Carole2,3,4, Tsague Kengni Hermann Nestor2,3, Kobe Fokalbo Zephanie3, Ngowe Ngowe Marcelin2
1St Elizabeth Catholic General Hospital Shisong, Cardiac Centre Shisong, Kumbo, Cameroon, 2Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon, 3Division of Cardiovascular Surgery, Yaoundé General Hospital, Yaoundé, Cameroon, 4National Social Insurance Fund Hospital, Yaoundé, Cameroon
&Corresponding author
Introduction: aortic pseudo-aneurysm (AP) is a rare and fearful complication that might occur following heart surgery with rates ranging between 0.5% and 8.5% in several series. It can occur in a variable period of time, from a few days to several years after surgery. AP has been associated to graft and surgical site infections, trauma, degenerative disease and surgical site leaks. Surgical repair remains the mainstay of therapy although associated with high mortality rates varying between 6.7% and 46% in several reports. Although endovascular repair has gained major attention in recent years as an alternative to conventional surgery in the treatment of AP, it is not always feasible or available as it’s the case in many developing countries.
We report the case of a 37-year-old sub-Saharan African female who underwent surgical repair for a giant retro-sternal pseudoaneurysm of the ascending aorta nine months after a double mechanical replacement and aortic root enlargement procedure.
Case presentation: a 37-year-old female with past history of double mechanical replacement and aortic root enlargement 9 months earlier was referred to our unit for a progressive, pulsatile and compressive discomfort in the back sternum for 2 weeks. She also complained of mild fatigue and sporadic episodes of chest pain in the left hemithorax with no dyspnea or palpitations.
The postoperative course at prior surgery was characterized by mild fever and superficial sternal wound dehiscence that was treated with oral antibiotics and wound medication for two weeks followed by complete healing. Transthoracic echocardiography at admission showed a good function of the previously implanted prosthetic valves with a mild reduction of left ventricular contractility (45%). A huge para-aortic cavity (9 x 10 cm) communicating with the aortic root was found in the left parasternal view, located in the anterior-right lateral segment of the ascending aorta. A subsequent Computed Tomography Angiography scan revealed a giant aortic pseudoaneurysm communicating to the aortic root. Considering the potential life-threatening evolution of the lesion, a consensual decision was taken with the patient and relatives for a surgical repair which was planned in an elective setting.
Cardiopulmonary bypass (CPB) was established by direct cannulation of the right axillary artery and the right femoral vein, and the patient was progressively cooled to 22°C. After exposure of the sternal bone, the patient was positioned in deep trendelenburg position and the CPB was interrupted. Sternal re-entry was then performed under a short deep hypothermic circulatory arrest. A fast exposure of the distal ascending aorta was achieved, and a cross-clamp was applied. CPB was then restarted with progressive systemic rewarming through the right axillary artery. After the removal of periaortic thrombi, an aortic tear was found on the previous aortic suture line for patch enlargement. An aortotomy was done and cardioplegia was delivered selectively in the coronary ostia. The aortic root and ascending aorta were meticulously inspected to rule out other lesions and the aortotomy closed with a new heterologous pericardial patch with continuous sutures reinforced with multiple interrupted pledgeted single sutures.
The patient was transferred to the intensive care unit and weaned from mechanical ventilation 5 hours after surgery. Postoperative echocardiograms showed no evidence of residual lesions in the aortic root and good function of both mechanical valves. The global postoperative course was uneventful, and the patient was discharged on the postoperative day 7th. A control Computed Tomography Angiography performed one month after discharge showed good surgical result with complete restoration of the aortic lumen.
