Almeida Samuel, Bico Pedro, Almeida António R, Laranjeira Santos Álvaro, Banazol Nuno, Fragata José, Rabaçal Carlos
Serviço de Cardiologia, Hospital de Vila Franca de Xira, Vila Franca de Xira, Lisboa, Portugal.
Serviço de Cardiologia, Hospital de Vila Franca de Xira, Vila Franca de Xira, Lisboa, Portugal.
Rev Port Cardiol. 2014 Feb;33(2):113.e1-5. doi: 10.1016/j.repc.2013.09.004. Epub 2014 Feb 7.
Pseudoaneurysms of the ascending aorta are a rare complication of cardiac surgery. However, the poor prognosis associated with this condition if untreated makes early diagnosis and treatment important. We present the case of a 66-year-old woman who had undergone mitral valvuloplasty 12 days previously, who was admitted with a diagnosis of new-onset atrial fibrillation. The transthoracic echocardiogram showed a clot in the right atrium and anticoagulation was initiated, followed by antibiotic therapy. After further investigation, the patient was diagnosed with a pseudoaneurysm of the ascending aorta and underwent surgical repair, followed by six weeks of antibiotic therapy. She was readmitted six months later for an abscess of the lower sternum and mediastinum. After a conservative approach with antibiotics and local drainage failed, recurrence of a large pseudoaneurysm compressing the superior vena cava was documented. A third operation was performed to debride the infected tissue and to place an aortic allograft. There were no postoperative complications.
升主动脉假性动脉瘤是心脏手术罕见的并发症。然而，若不治疗，该病症预后较差，因此早期诊断和治疗至关重要。我们报告一例66岁女性病例，她在12天前接受了二尖瓣成形术，因新发房颤入院。经胸超声心动图显示右心房有血栓，遂开始抗凝治疗，随后进行抗生素治疗。进一步检查后，患者被诊断为升主动脉假性动脉瘤并接受了手术修复，随后接受了六周的抗生素治疗。六个月后，她因下胸骨和纵隔脓肿再次入院。在抗生素和局部引流的保守治疗方法失败后，记录到一个大的假性动脉瘤复发，压迫上腔静脉。进行了第三次手术，清创感染组织并植入主动脉同种异体移植物。术后无并发症。
