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Background Pseudoaneurysms of the thoracic ascending aorta are a rare complication after cardiac surgery. Postsurgical etiologies include infection and anastomotic dehiscence along suture lines and cannulation sites. 1 The authors describe a case of a patient after an aortic valve replacement, in whom immediate postbypass transesophageal echocardiography suggested aortic disruption that later manifested as an aortic pseudoaneurysm requiring emergent surgical intervention.

A 53 year old male with a history of vascular ring repair secondary to a right sided aortic arch with retroesophageal subclavian artery and ligamentum arteriosum to the descending thoracic aorta presented to our institution with a large aortic pseudoaneurysm of the distal aortic arch. Computed tomography demonstrated a right sided aortic arch with a 5.8 cm pseudoaneurysm arising from the distal arch in the area of his previously divided ligamentum. The patient underwent a successful two-stage repair including a left carotid to subclavian bypass followed by total arch replacement with frozen elephant trunk. He recovered well postoperatively and computed tomography showed complete repair of the pseudoaneurysm with patent bypass graft.