Tobías-Castillo Pablo E, Oristrell Gerard, Reyes-Juárez José Luis, Martí-Aguasca Gerard
Cardiology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER CV), Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.
Eur Heart J Case Rep. 2023 Aug 31;7(9):ytad414. doi: 10.1093/ehjcr/ytad414. eCollection 2023 Sep.
Ascending aortic pseudoaneurysms (AAPs) are an unusual complication of cardiac or aortic surgery and are associated with a high risk of complications and mortality. Guidelines recommend surgical repair. There is few data concerning percutaneous occlusion of AAP. We present a case of syncope due to vascular and heart chamber compression by a large post-surgical AAP that was filled through a focal leak. Ascending aortic pseudoaneurysm was successfully occluded percutaneously.
A 66-year-old man with a mechanical aortic prosthesis and a Dacron tube in the ascending aorta presented with syncope due to compression of the right atrium and superior vena cava by a large peritube collection. A computed tomography angiography (CTA) showed a large AAP that was filled through a small focal dehiscence of the tube proximal suture. Patient was dismissed for surgery due to high surgical risk. Then, AAP was successfully occluded percutaneously via a 6-French radial access and local anaesthesia.
In patients with syncope and previous cardiac surgery, aortic complications should be ruled out. Although transthoracic echocardiography may be useful, CTA is the recommended diagnostic test for ruling out post-surgical AAP and allows the characterization of the number, localization, and size of the leaks. In selected patients with high surgical risk and favourable anatomic characteristics, a percutaneous closure could be indicated.
升主动脉假性动脉瘤（AAPs）是心脏或主动脉手术后一种罕见的并发症，与高并发症风险和死亡率相关。指南推荐手术修复。关于经皮封堵AAP的数据很少。我们报告一例因大型术后AAP通过局灶性渗漏充盈导致血管和心腔受压而出现晕厥的病例。升主动脉假性动脉瘤经皮封堵成功。
一名66岁男性，植入机械主动脉瓣膜且升主动脉有涤纶补片，因右心房和上腔静脉被补片周围大量积液压迫而出现晕厥。计算机断层血管造影（CTA）显示一个大型AAP，通过补片近端缝线处的小局灶性裂开充盈。因手术风险高，患者未进行手术。随后，通过6F桡动脉途径和局部麻醉成功经皮封堵AAP。
对于有晕厥且既往有心脏手术史的患者，应排除主动脉并发症。虽然经胸超声心动图可能有用，但CTA是排除术后AAP并确定渗漏数量、位置和大小的推荐诊断检查。对于手术风险高且解剖特征有利的特定患者，可考虑经皮封堵。
