Fedriga E, Diehl L, Paganini V, Morello M
I Servizio di Radiologia, IRCCS, Ospedale Maggiore-Policlinico, Milano.
Cardiologia. 1996 Jul;41(7):661-5.
Aortic pseudoaneurysm starts as small disruption of the aortic wall with an extravasation of blood into the mediastinum, contained only by fibrous tissue and by parietal pericardium. The most common cause of this condition is dehiscence or inflammatory processes of suture stitches after surgical interventions on aortic value or ascending sorts. Pseudoaneurysm represents about 40% of complications of cardiac surgery involving the ascending sorts. This complication occurs in about 1% of cases of aortic valve or ascending tract replacement. In this study, we evaluated, with different diagnostic techniques, 4 patients (all males, mean age 48 +/- 23 years, range 17-74) affected by aortic pseudoaneurysm occurring at different times after surgical intervention on the sorts. Clinically only 1 of the 4 patients referred chest pain. Repeated chest radiography and cardiac magnetic resonance were performed in every patient; 3 subjects were evaluated by transthoracic and transesophageal echocardiography; contrast-enhanced computed tomography was performed in 1 patients. Pseudoaneurysm diagnosis obtained by non invasive methods was later confirmed and better described by angiography. Our study demonstrated that transesophageal echocardiography and magnetic resonance are useful and reliable methods in the diagnosis of aortic pseudoaneurysm. However, in case of mediastinal he or pericardial effusion (suggestive of aortic pseudoaneurysm) by transesophageal echocardiography or magnetic resonance, angiography is necessary and may show the exact rupture site on the aortic wall. This diagnostic approach yields enough information for both diagnosis and surgical correction of this rare but high-risk pathological condition.
主动脉假性动脉瘤开始于主动脉壁的小破裂，血液渗入纵隔，仅由纤维组织和心包壁层包绕。这种情况最常见的原因是在主动脉瓣或升主动脉进行手术干预后缝线的裂开或炎症过程。假性动脉瘤约占涉及升主动脉的心脏手术并发症的40%。这种并发症发生在约1%的主动脉瓣或升主动脉置换病例中。在本研究中，我们采用不同的诊断技术评估了4例（均为男性，平均年龄48±23岁，范围17 - 74岁）在升主动脉手术干预后不同时间发生主动脉假性动脉瘤的患者。临床上4例患者中只有1例诉说胸痛。对每位患者均进行了多次胸部X线摄影和心脏磁共振检查；3例患者接受了经胸和经食管超声心动图检查；1例患者进行了增强计算机断层扫描。通过非侵入性方法获得的假性动脉瘤诊断后来通过血管造影得到证实并得到更好的描述。我们的研究表明，经食管超声心动图和磁共振成像在主动脉假性动脉瘤的诊断中是有用且可靠的方法。然而，在经食管超声心动图或磁共振成像提示纵隔血肿或心包积液（提示主动脉假性动脉瘤）的情况下，血管造影是必要的，并且可以显示主动脉壁上的确切破裂部位。这种诊断方法为这种罕见但高风险的病理状况的诊断和手术矫正提供了足够的信息。
