Ronen Daniel, Planer David, Beeri Ronen, Korach Amit, Elbaz Greener Gabby, Rahamim Eldad
Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel.
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Front Cardiovasc Med. 2025 Sep 3;12:1532920. doi: 10.3389/fcvm.2025.1532920. eCollection 2025.
We report a case of an ascending aortic pseudoaneurysm that developed as a complication of coronary artery bypass graft surgery and was managed with percutaneous endovascular repair. A 59-year-old man presented 9 months after bypass surgery, with complaints of dysphagia and shortness of breath. Computed tomography and echocardiography demonstrated a pseudoaneurysm of the ascending aorta. The patient's overall condition put him at a very high perioperative risk, prohibiting surgical intervention. However, the patient deteriorated clinically and suffered cardiac arrest, requiring repeated resuscitation efforts. In need of an urgent solution, the heart team recommended the interventional cardiology team perform a percutaneous endovascular repair, which resulted in significant hemodynamic improvement. Patients' clinical improvement allowed the surgical team to conduct a sternotomy to remove substantial mediastinal blood clots and place a bovine patch on a residual aortic leak. After recovery, the patient was discharged home and at 1-year follow-up is doing well. This case demonstrates the feasibility of percutaneous endovascular treatment in medical emergencies of the ascending aorta, when standard surgical treatment carries unacceptable risk.
我们报告一例升主动脉假性动脉瘤病例，该病例是冠状动脉旁路移植术的并发症，并采用经皮血管腔内修复术进行治疗。一名59岁男性在旁路手术后9个月就诊，主诉吞咽困难和呼吸急促。计算机断层扫描和超声心动图显示升主动脉假性动脉瘤。患者的整体状况使其围手术期风险非常高，禁止进行手术干预。然而，患者临床病情恶化并发生心脏骤停，需要反复进行复苏努力。由于急需解决方案，心脏团队建议介入心脏病学团队进行经皮血管腔内修复，结果血流动力学得到显著改善。患者的临床改善使手术团队能够进行胸骨切开术，以清除大量纵隔血凝块，并在残留的主动脉漏口处放置牛心包补片。康复后，患者出院回家，1年随访时情况良好。该病例表明，当标准手术治疗风险不可接受时，经皮血管腔内治疗在升主动脉医疗紧急情况中是可行的。
