title: Huge ruptured and infected pseudoaneurysm of the ascending aorta and aortic arch with erosion of sternum after previous cardiac surgery.
abstract: A 77-year-old woman underwent aortic valve replacement and coronary bypass grafting in 2007 in the Emirates. Evolution was uneventful until December 2011. After repeated episodes of unspecific infections, a computed tomographic scan showed a large pseudoaneurysm of the distal ascending aorta. The site of aortic rupture was closed with a Gore-Tex patch and a Staphylococcus aureus infection treated appropriately. Two months later, a small cutaneous lesion on the cranial part of the sternotomy started bleeding. Computed tomographic scan demonstrated recurrence of a false aneurysm with erosion of the sternum and a large subcutaneous hematoma caused by the fistula. The patient was transferred to our institution. The challenges of this case included safe surgical approach (sternotomy, cannulation, perfusion, cerebral protection) as well as complete removal and extensive debridement of the infected material and reconstruction of the aortic arch. Using fully biological material, reconstruction of the ascending aorta and proximal arch was successfully performed.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland. thierry.carrel@insel.ch
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: David
authors.initials: D
authors.lastname: Reineke
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003646:Debridement; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006406:Hematoma / Q000209:etiology; D006801:Humans; D011474:Prosthesis Design; D012086:Reoperation; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D056346:Sternotomy / Q000009:adverse effects*; D013249:Sternum / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome