title: Intraoperative transoesophageal echocardiographic diagnosis and successful management of mycotic aortitis and pseudoaneurysm.
abstract: A 38-year-old intravenous drug using man was scheduled for urgent pericardial window surgery to treat pericardial effusion and tamponade. Transoesophageal echocardiography (TOE) during the procedure revealed a minor residual effusion and an atypical heterogenous thickened appearance of the pericardium and adjoining aortic root. Interrogation of the aortic valve with a 'panning' manoeuvre from the mid-oesophageal aortic valve short axis view showed a small hypoechoic lesion between the right and non-coronary cusp at the level of the sinus of Valsalva. Postoperative high-resolution contrast CT confirmed the anaesthesia TOE findings of a small pseudoaneurysm. The decision was then made to proceed to formal aortic root replacement after 5 days of directed antibiotic therapy and evidence of an increase in aneurysm size to 2.7 cm on repeat CT angiogram. The patient made a good postoperative recovery and was eventually discharged from the hospital 3 weeks after his second operation.
authors.affiliation: Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Chong Oon
authors.initials: CO
authors.lastname: Tan
authors.forename: Laurence
authors.initials: L
authors.lastname: Weinberg
authors.forename: Parameswan
authors.initials: P
authors.lastname: Pillai
authors.forename: Jon
authors.initials: J
authors.lastname: Fernandes
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000785:Aneurysm, Infected / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D000792:Angiography / Q000379:methods; D001013:Aorta, Thoracic; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001025:Aortitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D002305:Cardiac Tamponade / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome