Percutaneous closure of a large ascending aortic pseudoaneurysm

Abstract

Pseudoaneurysm of the ascending aorta is a rare complication, usually after thoracic surgery or trauma.Since surgical repair is associated with very high morbidity and mortality, percutaneous closure has been described as an alternative.In this regard, we present a case in which a symptomatic large pseudoaneurysm of the ascending aorta was treated percutaneously due to the high surgical risk.Despite the technical difficulties, this procedure had a good final result followed by clinical success. © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved. PALAVRAS-CHAVEAorta ascendente; Pseudoaneurisma; Encerramento percutâneo Encerramento percutâneo de um volumoso pseudoaneurisma da aorta ascendenteResumo O pseudoaneurisma da aorta ascendente consiste numa complicação rara, habitualmente na sequência de cirurgia cardiotorácica ou traumatismo.Dado que a reparação cirúrgica do mesmo se associa a uma elevada morbimortalidade, o encerramento percutâneo tem vindo a ser descrito como uma alternativa viável. * Corresponding author. E-mail address: marta.afonso.nogueira@gmail.com (M.A. Nogueira). 2174-2049Document downloaded from http://www.elsevier.pt, day 09/03/2016. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 119.e2 M.A. Nogueira et al.Neste contexto, apresentamos um caso caracterizado por um volumoso e sintomático pseudoaneurisma da aorta ascendente, o qual fora submetido a tratamento percutâneo, devido ao elevado risco cirúrgico.Apesar das dificuldades do ponto de vista técnico, este procedimento obteve um bom resultado final, com sucesso em termos clínicos.

Minimally Invasive Device Repair of Ascending Aortic Pathology in Selected High-risk Patients

“…Nevertheless, patients have increasingly become elderly with multiple medical comorbidities, and recent interest has shifted toward less invasive methods of therapy, such as coil embolization and transcatheter interventions using occluder or stent grafts in high-risk patients. [1][2][3][4][5][6][7][8] The benefits of percutaneous transcatheter closure include its relative ease of use, avoidance of general anesthesia, lower surgical morbidity, and mortality. However, some challenging issues remain for each of these approaches.…”

“…Intimal tear in ascending aortic pathology is an uncommon and catastrophic event, and open aortic replacement with cardio-pulmonary bypass is the gold standard. Nevertheless, patients have increasingly become elderly with multiple medical comorbidities, and recent interest has shifted toward less invasive methods of therapy, such as coil embolization and transcatheter interventions using occluder or stent grafts in high-risk patients 1–8 …”

“…Each patient had met the following criteria for MIDR: (1) isolated intimal tear in ascending aorta confirmed by transthoracic echocardiographic and computed tomography angiography (CTA);…”

“…

I ntimai tear in ascending aorta usually develops following aortic pathology, such as aortic dissection and aortic pseudoaneurysm after thoracic surgery. [1][2][3][4] Open aortic replacement is the conventionally gold standard for ascending aortic pathology.In this report, we describe our initial experience with a novel minimally invasive device repair (MIDR) for intimal tear in ascending aorta in high-risk patients under transesophageal echocardiographic (TEE) guidance.

METHODS

Patient's Clinical DetailsBetween January 2017 and January 2021, 10 selected patients with intimal tear in ascending aorta were selected for MIDR. Clinical data was summarized in Table 1.

…”

“…I ntimai tear in ascending aorta usually develops following aortic pathology, such as aortic dissection and aortic pseudoaneurysm after thoracic surgery. [1][2][3][4] Open aortic replacement is the conventionally gold standard for ascending aortic pathology.…”