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Internal thoracic artery pseudoaneurysm after redo aortic root replacement.

Yoshinori Kuroda1, Tetsuro Uchida1, Azumi Hamasaki1

  • 1Division of Cardiovascular Surgery, Department of Surgery II, Faculty of Medicine, Yamagata University, Yamagata, Japan.

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Summary

Pseudoaneurysm of the internal thoracic artery (ITA) is a rare complication after median sternotomy. Early detection and transcatheter embolization are crucial for managing this potentially life-threatening condition.

Keywords:
post aortic root replacementpseudoaneurysm of the internal thoracic arteryMarfan syndrome

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Median sternotomy is a common approach for cardiovascular surgery.
  • Complications, though rare, can arise from sternotomy, including vascular issues.
  • Internal thoracic artery (ITA) pseudoaneurysm is an exceptionally infrequent complication.

Observation:

  • A 49-year-old woman with Marfan syndrome developed a delayed, large pseudoaneurysm of the right ITA.
  • The patient had undergone redo aortic root replacement via re-median sternotomy and pacemaker implantation.
  • Diagnostic selective angiography identified the pseudoaneurysm's origin.

Findings:

  • Transcatheter embolization of the ITA was performed successfully, addressing the pseudoaneurysm.
  • Follow-up CT scans confirmed no contrast extravasation or recurrent hemorrhage.
  • This case highlights a rare but serious delayed complication post-sternotomy.

Implications:

  • Postoperative management after median sternotomy should include vigilance for ITA pseudoaneurysm.
  • Early detection and intervention, such as embolization, can prevent life-threatening bleeding.
  • Awareness of this complication is vital for cardiovascular and vascular surgeons.