EndoaortJc Occlusion With the Intraclude Device During the Management of Ascending Aortic Pseudoaneurysm

摘要

A 63-year-old man was admitted with chest pain after a previous aortic valve replacement. Computed tomographic scan identified a 7-cm pseudoaneurysm of the ascending aorta, and he was referred for repair. At operation, endoaortic occlusion of the aorta was used to arrest the heart and decompress the aorta to facilitate sternal reentry, dissection, and subsequent control. To our knowledge, this technique has not been reported and represents a useful maneuver in this challenging clinical situation. Aortic pseudoaneurysm formation most commonly originates from surgical suture lines. Other etiologies include infection, genetic disorders, and trauma.1'2 Incidence, risk factors, and natural history of aortic pseudoaneurysms are not well documented because only a few larger series are published. Symptoms may include dysphagia, stridor, chest pain, or the presence of a pulsatile mass. The underlying pathological mechanism is a disruption of the intima and media of the aorta. The adventitia and the surrounding structures of the mediastinum have the transient ability of avoiding an acute rupture in these patients. If untreated, aortic pseudoaneurysms typically grow over time, which may lead to aortic rupture. As such, prompt intervention is usually advised. The surgical management of ascending aortic pseudoaneurysms can be challenging, especially in the reoperative setting. We describe a technique that facilitates management and helps minimize the operative risk.