DefinePK

Research Objective

To describe the trans-catheter management of a post-cardiac surgery aortic pseudoaneurysm in an elderly patient and review similar cases.

Methodology

Case report detailing the management of a 68-year-old female with a post-CABG ascending aortic pseudoaneurysm. The management involved trans-catheter device closure. A review of 3 similar cases managed via trans-catheter device closure is also discussed.

Methodology Flowchart

                        graph TD;
    A["Patient Presentation: 68yo female with post-CABG aortic pseudoaneurysm"] --> B["Diagnosis: CT-Aortogram, Echocardiography"];
    B --> C["Treatment Planning: MDT discussion"];
    C --> D["Intervention: Trans-catheter device closure"];
    D --> E["Procedure Outcome: Successful closure, no residual leak"];
    E --> F["Complications: Cardiac arrest, septic shock"];
    F --> G["Patient Outcome: Death"];
    D --> H["Literature Review: 3 similar cases"];
    G --> I["Conclusion: Transcatheter closure potential, need for more studies"];
    H --> I;                    

Discussion

The discussion highlights the rarity and severity of post-cardiac surgery aortic pseudoaneurysms, particularly in elderly females. It compares the case to three other reported cases managed successfully with trans-catheter device closure, noting that these patients were younger and had uneventful recoveries. The benefits of lower morbidity with interventional procedures are discussed, especially when surgical approaches are contraindicated. The importance of meticulous surgical technique during cardiac surgery to minimize aneurysm formation is emphasized.

Key Findings

A 68-year-old female developed a 44 mm ascending aortic pseudoaneurysm 7 days after CABG. Trans-catheter device closure was performed, and the neck was successfully closed with no residual leak. However, the patient developed cardiac arrest during the procedure, followed by septic shock, which ultimately led to her death.

Conclusion

Transcatheter device closure is presented as an attractive and newer modality for managing ascending aortic pseudoaneurysms. However, the authors suggest that more studies are needed to compare its efficacy with open surgical repair in various settings.

Fact Check

1. The patient was a 68-year-old female. (Confirmed in the text)
2. The pseudoaneurysm was 44 mm large. (Confirmed in the text)
3. The pseudoaneurysm was located just above the vein graft to the RCA. (Confirmed in the text)

Mind Map