Giant aortic root pseudoaneurysm surrounding the left main coronary artery
Zjuul Segers1, Patrick Houthuizen2, Albert H M van Straten3
1Department of Anesthesiology, Zuyderland Medical Centre, Heerlen, Eindhoven, The Netherlands.
Annals of Cardiac Anaesthesia
|November 8, 2021
Summary
Aortic valve endocarditis caused a pseudoaneurysm that surrounded the left coronary artery. Reoperation was necessary due to pseudoaneurysm growth and paravalvular regurgitation, despite no signs of ischemia.
Area of Science:
- Cardiovascular Surgery
- Infective Endocarditis
- Cardiac Imaging
Background:
- A 69-year-old patient presented with Streptococcus agalactiae endocarditis affecting the native aortic valve.
- Initial treatment involved urgent aortic valve replacement.
Observation:
- Postoperative follow-up revealed rapid progression of an abscess cavity into an aortic root pseudoaneurysm.
- The pseudoaneurysm exhibited increasing paravalvular regurgitation.
Findings:
- Preoperative transesophageal echocardiography (TEE) demonstrated the pseudoaneurysm encasing the left coronary artery (LCA).
- Crucially, no signs of myocardial ischemia were detected despite the LCA encirclement.
Implications:
- This case highlights the complex management of aortic root pseudoaneurysms secondary to endocarditis.
- Reoperation was indicated due to pseudoaneurysm expansion and associated complications.
- The absence of ischemia despite LCA compression underscores the importance of detailed imaging and careful surgical planning.
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