Papadopoulos Georgios E, Ninios Ilias, Evangelou Sotirios, Ioannides Andreas, Ninios Vlasis
Cardiology Department, Interbalkan Medical Center, Thessaloniki, Greece.
Egypt Heart J. 2025 Jun 16;77(1):62. doi: 10.1186/s43044-025-00663-x.
Ascending aortic pseudoaneurysm is a rare but potentially fatal complication following cardiac surgery. Its management is particularly challenging in elderly or frail patients due to the high risk associated with repeat sternotomy. This case is notable for the successful use of a transcatheter approach to treat a pseudoaneurysm arising just above a sutureless aortic valve bioprosthesis-an unusual anatomical location that poses unique technical challenges.
An 83-year-old man with a history of hypertension underwent surgical aortic valve replacement with a large-size sutureless bioprosthetic valve. Five months later, he presented with chest heaviness. Imaging with computed tomography angiography and aortography revealed an ascending aortic pseudoaneurysm located 1.5 cm above the upper edge of the prosthetic valve frame. Due to his advanced age and stable clinical condition, a percutaneous approach was selected. Access was obtained via the right femoral artery, and angiography was performed using a pigtail catheter. An initial attempt to close the defect with a 22 mm atrial septal defect occluder failed due to inadequate anchoring. A 32 mm device was then successfully deployed, sealing the pseudoaneurysm without interfering with valve function. The patient remained hemodynamically stable throughout the procedure and had an uneventful recovery. Follow-up imaging at six months confirmed stable device positioning, complete exclusion of the pseudoaneurysm from systemic circulation, and no thrombus formation. The patient remained asymptomatic.
This case demonstrates that transcatheter closure of ascending aortic pseudoaneurysms is a viable and safe alternative to surgical repair in selected high-risk patients. The successful use of an atrial septal defect occluder above a sutureless aortic valve prosthesis highlights the adaptability of percutaneous closure devices and the importance of individualized procedural planning. This approach may expand treatment options for patients otherwise considered inoperable.
升主动脉假性动脉瘤是心脏手术后一种罕见但可能致命的并发症。由于再次开胸手术相关风险高，其治疗在老年或体弱患者中尤其具有挑战性。该病例值得注意的是成功采用经导管方法治疗位于无缝合主动脉瓣生物假体上方的假性动脉瘤，这一不寻常的解剖位置带来了独特的技术挑战。
一名有高血压病史的83岁男性接受了大型无缝合生物假体主动脉瓣置换手术。五个月后，他出现胸部闷痛。计算机断层血管造影和主动脉造影成像显示，假性动脉瘤位于人工瓣膜框架上缘上方1.5厘米处。由于他年事已高且临床状况稳定，选择了经皮途径。通过右股动脉进行穿刺，使用猪尾导管进行血管造影。最初尝试用22毫米房间隔缺损封堵器封闭缺损，但由于固定不充分而失败。随后成功部署了一个32毫米的装置，封闭了假性动脉瘤，且未干扰瓣膜功能。整个手术过程中患者血流动力学稳定，恢复顺利。六个月后的随访成像证实装置位置稳定，假性动脉瘤完全排除在体循环之外，且无血栓形成。患者仍无症状。
该病例表明，对于选定的高危患者，经导管封闭升主动脉假性动脉瘤是一种可行且安全的手术修复替代方法。在无缝合主动脉瓣假体上方成功使用房间隔缺损封堵器突出了经皮封堵装置的适应性以及个体化手术规划的重要性。这种方法可能会扩大原本被认为无法手术的患者的治疗选择。
