Retrosternal pseudoaneurysm eroding the sternum in a patient six years after aortic valve replacement.

摘要

A 67-year-old woman was admitted for increased bleeding of a chronic ulceration on the sternum and symptoms of chest pain, dysphagia, and hoarseness. She had an aortic-valve replacement with a 27-mm St. Jude Medical mechanical valve (St. Jude Medical, Syl-mar, CA, USA) 6 years earlier because of severe aortic insufficiency. Ascending aorta diameter was 4.2 cm at the time of the surgery. Her complaints started 1 year ago and accelerated in the last 2 months. On physical examination, an ulceration on the lower sternum was detected (Fig. 1A). Her heart rate was 105 bpm and blood pressure was 110/70 mmHg. Abnormal systolic impulse was palpated around the ulceration. Electrocardiogram was unremarkable with no signs of myocardial ischemia. Chest X-ray showed a widened mediastinum. Dilated ascending aorta and a large pseudoaneurysm of the aortic root was detected on transthoracic echocargiography (Fig. 1B). A computed tomographic scan of the chest revealed severe enlargement of the ascending aorta and pseudoaneurysm of the aortic root behind the sternum (Fig. 1C). The pseudoaneurysm caused the erosion of the sternum and skin. The patient underwent hemiarch replacement using the separated graft technique. The preferred cannu-lation site was femoral-femoral, with deep hypothermic circulatory arrest before opening the sternum. The postoperative course was uneventful.