RESUMEN
Pseudoaneurysm formation has been reported in degenerated coronary artery saphenous vein bypass grafts, as well as in native coronary arteries after interventional procedures or blunt trauma. In contrast, pseudoaneurysm formation arising from the anastomotic site of native coronary vessels soon after coronary artery bypass grafting is rare, and neither the clinical presentation of this phenomenon nor its treatment is well described. We present the case of a 63-year-old man, a recent coronary artery bypass grafting patient, who presented with acute coronary syndrome due to a large and expanding pseudoaneurysm of the saphenous vein-to-ramus intermedius artery graft anastomosis. After several attempts, we successfully treated the pseudoaneurysm by means of percutaneous coil embolization. To our knowledge, this is the first report of acute coronary syndrome secondary to a pseudoaneurysm at the coronary artery-saphenous vein graft anastomosis. In addition, this appears to be the first report of the percutaneous treatment of such a pseudoaneurysm by means of coil embolization.
Asunto(s)
Síndrome Coronario Agudo/etiología , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Puente de Arteria Coronaria/efectos adversos , Vasos Coronarios/cirugía , Vena Safena/cirugía , Anastomosis Quirúrgica/efectos adversos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare but serious sequela of endocarditis or valve replacement surgery. Because open-heart surgery is a high-risk treatment option, alternative methods are sought. We present the case of a 77-year-old man with a noninfected mechanical mitral valve whose pseudoaneurysm was repaired by introducing an occluder device into the defect by a transapical approach. Upon follow-up imaging, the defect was successfully closed. We conclude that percutaneous closure of pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a viable alternative to surgery and that a transapical approach is an appropriate method of access.
Asunto(s)
Aneurisma Falso/cirugía , Aneurisma Cardíaco/cirugía , Anciano , Válvula Aórtica , Procedimientos Quirúrgicos Cardíacos/métodos , Humanos , Masculino , Válvula MitralRESUMEN
Left ventricular outpouchings are increasingly detected on cardiovascular imaging. Herein, we describe the case of a 45-year-old man who underwent noncardiac preoperative imaging and was found to have an asymptomatic left ventricular outpouching. The patient underwent successful surgical repair of the structure. When left ventricular outpouchings are detected, the main differential diagnoses are pseudoaneurysm, aneurysm, and diverticulum. The outcomes for these conditions differ substantially, and accurate diagnosis can be crucial in making clinical decisions. We review the relevant medical literature, outline the natural history of these left ventricular abnormalities, and discuss options in regard to their management.
Asunto(s)
Divertículo/diagnóstico , Aneurisma Cardíaco/diagnóstico , Cardiopatías/diagnóstico , Enfermedades Asintomáticas , Procedimientos Quirúrgicos Cardíacos , Diagnóstico Diferencial , Divertículo/cirugía , Aneurisma Cardíaco/cirugía , Cardiopatías/cirugía , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Ventriculografía con Radionúclidos , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía Doppler en ColorRESUMEN
Aortic pseudoaneurysm is a rare, life-threatening complication after cardiac or aortic root surgery. When a pseudoaneurysm has eroded bony structures in the chest, the surgeon's challenge is to choose the safest approach for sternotomy. Herein, we report the case of a 74-year-old woman who presented with a giant pseudoaneurysm of the ascending aorta, 8 years after undergoing aortic valve replacement. The 8.9×5.8-cm formation arose in the anterior aortic sinus, extended to the retrosternal region, exerted mass effect on the main pulmonary artery, and eroded the bony structures of the sternum and medial upper chest. A new aortic valved tissue conduit was placed, and the coronary arteries were reimplanted. The patient recovered without neurologic sequelae. We discuss the characteristics of this case and explain our surgical decisions.
Asunto(s)
Aneurisma Falso/cirugía , Aneurisma de la Aorta/cirugía , Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis Vascular , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/etiología , Aortografía/métodos , Bioprótesis , Puente Cardiopulmonar , Vasos Coronarios/cirugía , Remoción de Dispositivos , Ecocardiografía Transesofágica , Femenino , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Diseño de Prótesis , Reoperación , Reimplantación , Esternotomía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Isolated spontaneous rupture of the superficial femoral artery is very uncommon. To our knowledge, only 5 other cases have been reported in the medical literature. Herein, we report the case of an 86-year-old woman who was admitted to our hospital with a 4-day history of progressive swelling of the left thigh. The presence of a pulsating mass with paresthesia of the lower limb and anemia suggested a hematoma of the thigh. A computed tomographic scan revealed a 4-cm-diameter pseudoaneurysm of the left superficial femoral artery and a large hematoma of the medial muscle compartment. A nitinol-polytetrafluoroethylene VIABAHN self-expanding stent-graft (5-mm diameterx50-mm length) was placed beyond the arterial lesion, and a fasciotomy of the thigh was performed. On the 10th postoperative day, the patient was discharged from the hospital in good condition. In cases of spontaneous swelling of the thigh in the absence of trauma or other apparent causes, spontaneous rupture of the superficial femoral artery should be suspected. Surgical treatment is preferable in young patients. In patients who are elderly or in poor condition, endovascular therapy is preferable when there is diffuse atherosclerosis of the artery.