title: Direct percutaneous transaortic approach for treatment of aortic pseudoaneurysms.
abstract: Aortic pseudoaneurysms (APAs) can develop months or years after aortic and cardiac surgery. If not treated appropriately, APAs can lead to fatal complications and ultimately death. We describe a case of a 61-year old patient with a diagnosed large pseudoaneurysm 5 years after his aortic valve surgery, who was treated with a novel transcatheter direct transaortic approach. The patient had dilated cardiomyopathy with an APA adjacent to the lower sternal plate. An Amplatzer septal occlusion device followed by coils was delivered transcutaneously through the APA to close its neck and fill the false aneurysm, respectively. Triple fusion multimodality imaging was used to guide the placement of the occlusion devices. The merging of computed tomography (CT) and echocardiography with real-time fluoroscopy was fundamental in procedural planning and guidance. Post-procedural transoesophageal echocardiogram (TOE) and CT angiography showed complete exclusion of the APA. A direct transaortic approach is a valid option for closure of an APA if the surgical risk is prohibitive, and the use of triple fusion technology is an essential tool in the hands of interventionalists and surgeons for preoperative planning and conduction of these procedures.
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, New York, NY, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Pirelli
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, New York, NY, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Kliger
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, New York, NY, USA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Fontana
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, New York, NY, USA cruiz@nshs.edu.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Ruiz
mesh_terms: D017541:Aneurysm, False / Q000175:diagnosis* / Q000628:therapy*; D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods; D001013:Aorta, Thoracic; D001024:Aortic Valve Stenosis / Q000601:surgery; D001999:Bronchoscopy / Q000379:methods; D006328:Cardiac Catheterization; D017548:Echocardiography, Transesophageal / Q000379:methods; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D019233:Retreatment / Q000379:methods; D018570:Risk Assessment; D055989:Septal Occluder Device; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Aortic aneurysm; Aortic operation