title: Surgical management of a giant ascending aortic pseudoaneurysm.
abstract: Aortic pseudoaneurysm is a rare, life-threatening complication after cardiac or aortic root surgery. When a pseudoaneurysm has eroded bony structures in the chest, the surgeon's challenge is to choose the safest approach for sternotomy. Herein, we report the case of a 74-year-old woman who presented with a giant pseudoaneurysm of the ascending aorta, 8 years after undergoing aortic valve replacement. The 8.9×5.8-cm formation arose in the anterior aortic sinus, extended to the retrosternal region, exerted mass effect on the main pulmonary artery, and eroded the bony structures of the sternum and medial upper chest. A new aortic valved tissue conduit was placed, and the coronary arteries were reimplanted. The patient recovered without neurologic sequelae. We discuss the characteristics of this case and explain our surgical decisions.
authors.affiliation: Department of Cardiothoracic Surgery, University of Miami Hospital, Miller School of Medicine, Miami, Florida 33125, USA. jgaristomd@yahoo.com
authors.forename: Juan D
authors.initials: JD
authors.lastname: Garisto
authors.forename: Andres
authors.initials: A
authors.lastname: Medina
authors.forename: Donald B
authors.initials: DB
authors.lastname: Williams
authors.forename: Roger G
authors.initials: RG
authors.lastname: Carrillo
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001705:Bioprosthesis; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D003331:Coronary Vessels / Q000601:surgery; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D011474:Prosthesis Design; D012086:Reoperation; D012092:Replantation; D056346:Sternotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome