Clinical picture

Comprehensive definition of a giant ascending aortic pseudoaneurysm A 48-year-old man who had previously undergone a Bentall procedure came to our Emergency Department after 4 days of retrosternal discomfort and mild dyspnea. Electrocardiography showed sinus rhythm and normal ventricular repolarisation, and there was no increase in myocardial enzyme levels. A chest X-ray showed an enlarged mediasti-num, and CT revealed the presence of a large locu-lated pseudoaneurysm of the ascending aorta arising from the distal anastomosis of the conduit and extending to the posterior aspect of the sternum (Figure 1A and B). The patient was immediately transferred for repeat surgery involving a carefully executed median sternotomy. After establishing hypothermic circulatory arrest (288C), the pseudoa-neurysm was radically resected, a biological stent-less valve and new prosthetic aortic conduit were inserted, and the coronary ostia were re-implanted. The patient was weaned from the cardiopulmonary bypass pump with satisfactory hemodynamic results, and no major post-operative complications were observed during his hospital stay. Aortic root pseudoaneurysm is a rare complica-tion of aortic valve surgery,1 and a precise pre-operative diagnosis is critical in order to avoid an inadvertent rupture of the pseudoaneurysm Figure 1. Pre-operative multidetector CT scan showing the ascending aortic pseudoaneurysm, and its spatial relationships to the aortic graft and sternum. (A) Volume rendering (VR) image. (B) Axial image during the arterial contrast phase. Ao, aorta; Pseudo, pseudoaneurysm; ST, sternum; PA, pulmonary artery