Percutaneous closure of aortic pseudoaneurysm

To the Editor, Aortic pseudoaneurysm is a rare high-risk complication following surgery with aortic manipulation. This is the case of a 66-year-old male patient with a past medical history of aortic valve replacement 16 years ago. He required a second surgery 3 months later due to prosthetic valve endocarditis with mechanical valve replacement with homograft valve implantation. Since then, the patient has remained asymptomatic until 1 year ago when he developed progressive dyspnea. The echocardiographic study revealed severe aortic regurgitation with heavily calcified valve and ascending aorta. A new surgical intervention was performed to replace the homograft by a bioprosthesis. Surgery was very complex due to the presence of significant calcification. Two months after this last intervention the patient was admitted with clinical signs of thoracic pain and hemoptysis. The computed tomography scan performed revealed the presence of a narrow-necked aortic pseudoaneurysm at the ascending aorta lateral wall, probably at the level of the cannulation performed during the previous surgery with a large periaortic hematoma (figure 1). Although the surgical repairment of the aortic pseudoaneurysm is the routine treatment, in this case it would have been the fourth reintervention. Instead, percutaneous treatment was decided.