Endovascular Closure of 2 Subannular Pseudoaneurysms of the Aortic Root After Surgical Aortic Valve Replacement

Abstract

A 68-year-old woman was initially admitted with 2 subannular pseudoaneurysms of the aortic root after aortic valve replacement. The aneurysm expanded after 10 days and was treated using endovascular closure devices. ( Level of Difficulty: Advanced. )

Transcatheter occlusion of a left ventricular outflow tract pseudoaneurysm using a “plug and coil” strategy

“…A similar strategy has been described by Khanji et al, 7 who successfully used a retrograde technique to deliver the occlusive material into an ascending aorta PsA. In their case, Khelimskii et al 8 opted for a coil‐only strategy to treat a similar but smaller LVOT PsA via retrograde access through a bioprosthetic aortic valve.…”

Emergent percutaneous closure of sub-annular aortic root pseudoaneurysm in the setting of composite graft dehiscence: a case report

“… 8 , 9 Endovascular coiling has been demonstrated on multiple occasions. 5 , 8 De Boo et al 6 highlight a case where the defect reopened 8 years after the original coiling, requiring re-intervention and closure with an AVP2. 6 Endovascular coiling and a Foramen Ovale Occluder have even been used together to close a type A aortic dissection.…”

“…Despite recurrent evidence that percutaneous techniques can successfully close aortic defects, Khelimskii et al used coils in the only report of transcatheter closure of sub-annular aortic pseudoaneurysms. 5 The sub-annular location makes intervening difficult for reasons such as increased risk of arrhythmias and ventricular contractions decreasing equipment stability. Khelimskii et al 5 described being unable to achieve sufficient catheter support and needed to use a microcatheter system to deliver their MicroPlex Coil System.…”

“… 5 The sub-annular location makes intervening difficult for reasons such as increased risk of arrhythmias and ventricular contractions decreasing equipment stability. Khelimskii et al 5 described being unable to achieve sufficient catheter support and needed to use a microcatheter system to deliver their MicroPlex Coil System. In our case, we were able to sufficiently support our catheter enabling us to deliver an AVP2 and confirm its stability before release.…”

“… 4 There are sporadic cases of ascending aortic false aneurysms and dissections treated percutaneously. One technique is endovascular coiling 5–7 ; however, this has the risk of re-opening. 6 We are aware of one case were a sub-annular aortic root pseudoaneurysm was successfully coiled and one case using an Amplatzer Vascular Plug 2 (AVP2) to treat an ascending aortic pseudoaneurysm.…”