title: Repair of mycotic aortic pseudoaneurysm with a stent graft using transesophageal echocardiography.
abstract: A 54-year-old man who underwent uneventful orthotopic heart transplantation 1 year previously had low-grade fever and dyspnea. Imaging studies revealed an ascending aortic pseudoaneurysm (AAP), which was repaired with a 5-mm polyester patch, with circulatory arrest and cardiopulmonary bypass. Intraoperative cultures of the AAP grew methicillin-resistant Staphylococcus aureus, and the pseudoaneurysm recurred after 6 weeks despite intravenously administered antibiotic therapy. A 28.5-mm x 3.3-cm Gore Excluder aortic cuff was deployed in the ascending aorta through a left axillary artery cutdown with use of combined transesophageal echocardiography and fluoroscopy. In addition, controlled hypotension and asystole were established with administration of adenosine to facilitate precise device deployment. Postoperative imaging with transesophageal echocardiography and magnetic resonance angiography revealed complete resolution of the AAP, and the patient had done well at 7-month follow-up. Treatment of a mycotic aortic pseudoaneurysm with an endoprosthesis in a patient without other treatment alternatives can be performed safely, with acceptable short-term results.
authors.affiliation: Department of Vascular Surgery, Emory University, Atlanta, GA 30322, USA. srayan@emory.edu
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Rayan
authors.forename: J David
authors.initials: JD
authors.lastname: Vega
authors.forename: Jack S
authors.initials: JS
authors.lastname: Shanewise
authors.forename: Li Sheng
authors.initials: LS
authors.lastname: Kong
authors.forename: Elliot L
authors.initials: EL
authors.lastname: Chaikof
authors.forename: Ross
authors.initials: R
authors.lastname: Milner
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000601:surgery*; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000601:surgery*; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D017548:Echocardiography, Transesophageal; D006801:Humans; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000601:surgery*; D015607:Stents