Giant anastomotic pseudoaneurysm complicating aortic xenograft replacement

A 74-year-old woman was referred for investigation of a 2-week history of progressive dyspnea. Her medical history included an aortic valve replacement with a stentless bioprosthesis followed 13 months later by the replacement of the aortic root with a porcine xenograft. Transesophageal echocardiography revealed a giant circular pseudoaneurysm of the aortic xenograft with compression of the prosthetic aortic valve and concomitant severe aortic regurgitation. Dehiscence of the proximal graft anastomosis was also diagnosed, and a possible distal anastomotic dehiscence was suspected. The latter turned out intraoperatively to be an almost complete dehiscence of the right coronary artery. The patient died intraoperatively.