[Thrombosed pseudoaneurysm after aortic root replacement-sternal penetration with skin perforation as a late...

Aortic pseudoaneurysm is a potential complication after aortic root replacement. Occurrence has been reported up to 7% of cases, and is due to dehiscence of the anastomotic suture line. We report a case of sternum erosion and skin perforation 8 years after composite graft replacement as a consequence of a ventricular-aortic dehiscence that led to a giant spontaneously healed thrombotic pseudoaneurysm. Our patient developed a secondary sternal fistula without pain or other clinical symptoms. Chest Xray examination revealed an abnormal mediastinal mass. The tumor was recognized on a computed tomography scan; the mass was identified as spontaneously healed thrombosed pseudoaneurysma with sternal penetration. Repair could be performed on the beating heart. Postoperative right heart failure with signs of myocardial infarction was attributed to the chronically occluded right coronary artery.