[A case report of ruptured mycotic aneurysm at the site of subclavian flap angioplasty].

Postoperative mycotic aneurysm of the thoracic aorta at the site of subclavian flap angioplasty (SFA) is very rare. A 6-year-old boy was admitted with a history of high fever for 10 days. He had undergone SFA at the age of 14 days and patch closure of VSD at 10 months. The chest X-ray film on admission revealed no abnormality. But, 7 days later, he suffered from frequent hemoptysis and chest X-ray film showed an abnormal mass shadow at the left upper lung field. Contrast enhanced CT scan and IV-DSA revealed a pseudoaneurysm of the aortic arch which had ruptured into the left upper lung. An extra-anatomical bypass was urgently made from the ascending aorta to abdominal aorta and the aneurysm was isolated by ligations of the aorta proximal and distal to the aneurysm. Aneurysmectomy combined with left upper lobectomy was carried out next day. Septic signs and hemoptysis dramatically improved after operation. Extra-anatomical bypass as a means of choice for the surgical treatment of the mycotic aneurysm greatly contributed to cure the severe ill patient. But a close follow up observation for the function of the graft is necessary.