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Aortic Pseudoaneurysm with Fistulization to the Right Atrium: A Case Report
Marlena E. Sabatino, Kayla N. Laraia, NaYoung Yang, Joshua C. Chao, Leonard Y. Lee.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Objective: Aortic graft pseudoaneurysm (PsA) with local compression and fistulization is a rare complication of thoracic aortic surgery. Methods: Retrospective review of a patient who underwent PsA repair at our center. Results: A 67-year-old male with history of type A aortic dissection repair with aortic valve replacement 11 years prior, and subsequent 5.4 cm aortic root aneurysm repair with bio-Bentall 2 years prior, presented for routine yearly follow-up imaging. Computed tomography demonstrated an 8 cm ascending aortic graft PsA compressing nearby structures and with impending rupture (Fig.1). Patient reported chest pain, dyspnea on exertion, non-productive cough, abdominal pain, distention, and weight gain. Exam revealed blood pressure of 112/59 mmHg, diminished bibasilar breath sounds, and facial plethora. Upon redo-sternotomy, a dehiscence of the right coronary button at the graft-to-graft anastomosis was identified as the source of PsA bleed. The bleeding fistulized to the right atrium (Fig.2), mediating decompression and preserving biventricular function. During deep hypothermic circulatory arrest using fem-fem cardiopulmonary bypass, the heart fibrillated, and blood pressure was momentarily lost prior to chest opening. The anterior mediastinum was entered, the PsA was repaired, mediastinal hematoma evacuated, and right atrial fistula ligated. The patient was extubated two hours postoperatively, downgraded from intensive care postoperative day one, and discharged home postoperative day four. Recovery was uneventful at two-week follow-up. Conclusions: After undergoing two previous aortic surgeries, this patient developed a PsA causing right heart compression and pulmonary edema, with a good outcome after urgent surgery.


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