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 thrombus 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. © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. PALAVRAS-CHAVEPseudoaneurisma da aorta ascendente; Valvuloplastia mitral; Complicação pós-cirurgia cardíaca Pseudoaneurisma iatrogénico da aorta ascendente: uma complicação esquecidaResumo O pseudoaneunisma da aorta ascendente é uma complicação rara da cirurgia cardíaca. A sua elevada mortalidade torna importante o seu diagnóstico atempado e intervenção precoce.Os autores apresentam o caso de uma doente do sexo feminino, submetida a valvuloplastia mitral 12 dias antes, internada com o diagnóstico de fibrilhação auricular com resposta ventricular rápida. O ecocardiograma transtorácico inicial mostrou imagem sugestiva de trombo na aurícula direita, iniciou-se anticoagulação, seguida de terapêutica antibiótica. Investigação adicional com recurso a TC de tórax com contraste endovenoso permitiu concluir que se tratava de um pseudoaneurisma da aorta ascendente, pelo que a doente foi submetida a correção cirúrgica do mesmo, seguida de seis semanas de terapêutica antibiótica dirigida.A doente foi reinternada seis meses depois por abcesso na porção inferior do externo e mediastino. Após falha da terapêutica conservadora, com antibiótico e drenagem local, com agravamento clínico da doente, documentou-se reaparecimento de pseudoaneurisma de grandes dimensões com compressão da veia cava superior. Foi então submetida a terceira intervenção cirúrgica com desbridamento do tecido infetado e implantação de homoenxerto aórtico. O pós-operatório decorreu sem intercorrências.

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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.

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