Recurrence of Aneurysm of the Ascending Aorta after Patch Repair: The Fate of an Aortic Patch

Abstract

Pseudoaneurysm of the ascending aorta is a rare but lifethreatening complication after aortic cannulation and cardiovascular surgery, and it has the potential to rupture. We experienced a rare case of recurrence of aneurysm of the ascending aorta 7 years after patch repair of a small aneurysm at an aortic cannulation site. The repaired aorta had been wrapped with a Teflon felt strip during the previous surgery, and the wrapped aorta had become thin with deterioration of the normal structure of the aortic wall.Keywords: aortic aneurysm, pseudoaneurysm, patch repair ventricular myxoma when the patient was 42 years old under cardiac arrest with ascending aortic cannulation and aortic cross clamping. The second surgery was performed for a 30 mm saccular aneurysm of the ascending aorta at the previous aortic cannulation site when the patient was 61 years old. In the second surgery, the aneurysm was resected and the defect of the ascending aorta was closed with a 20 × 20 mm round polyester patch. The aortic wall was covered with three pieces of Teflon felt strip reinforcement, which was 10 mm width and was placed with 5 mm gap each (Fig.

Distinguishing sterile inflammation from graft infection

“…The aortic wall is nourished by vasa vasorum and endoluminal diffusion [ 19 – 21 ]; in TEVAR, an endovascular stent-graft covers the vessel luminal wall, disrupting both trophic pathways. As a result, necrosis of the intima [ 22 ], media [ 23 ], and adventitia [ 24 ] has been reported. In our patient, the cause of fluid collection around the vascular prosthesis was compression of the vaso-vasorum due to the use of an oversized stent and excessive stress being applied, resulting in aortic ischaemia and inflammatory changes, with inflammation potentially forming a non-infectious abscess.…”

A Tale of Three Surgeries: Management of a Massive Recurrent Mycotic Aortic Pseudoaneurysm

“…Simple patching has been used with success, 28 but there is a significant risk of local failure and recurrence of the pseudoa-neurysm. 29 Whether a previous aortic graft was implanted can influence the surgical strategy because it is reasonable to assume that the entire prosthetic graft may be infected, and hence, should be removed. This was not the case with the present clinical scenario.…”

Giant ascending aortic aneurysm after aortic valve replacement

“…Along with cystic medial degeneration, the use of nonbiodegradable grafts for aortic external wrapping may lead to wall thinning and late aneurysm formation 1 . Excessive wall stress imposed by too small or too thin Teflon felt strips or ischemic changes produced by vasa‐vasorum compression are usually involved in the pathogenesis 1 . Cystic medial degeneration is also associated with T‐lymphocyte and macrophage infiltration of the aortic wall 2 .…”