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Aortic root pseudoaneurysm: a case report and literature review
Pravinthiran Manokaran1, Sivakumar Krishnasamy2, Raja Rizal Azman Bin Raja Aman3
1Department of Cardiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Indian Journal of Thoracic and Cardiovascular Surgery
|December 21, 2023
Summary
Pseudoaneurysms of the aortic root, often caused by infections, are rare but serious. Surgical intervention offers a better outcome than medical treatment for these conditions, which commonly affect middle-aged males with a history of cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Radiology
Background:
- Pseudoaneurysms of the aortic root are rare cardiovascular emergencies.
- Infective endocarditis and prior cardiac surgery are significant risk factors.
- Aortic root abscess can progress to a ruptured pseudoaneurysm.
Purpose of the Study:
- To analyze the characteristics and outcomes of aortic root pseudoaneurysms.
- To review the literature on mycotic aneurysms and abscesses of the aortic root.
- To compare the efficacy of surgical versus medical management.
Main Methods:
- Systematic literature review of publications from 2000-2021 using keywords like 'aortic root mycotic aneurysm'.
- Analysis of 157 cases from 152 publications.
- Review of diagnostic modalities including transesophageal echocardiography and CT aorta.
Main Results:
- Aortic pseudoaneurysm predominantly affects males (80.9%) with a mean age of 51 years.
- Fever is the most common symptom (68.5%), and diagnosis takes a mean of 27.2 days.
- Valvular infections (45.9%) are the leading cause, with Staphylococcus and Streptococcus species being common pathogens.
- Prior cardiac surgery (49.0%) is a frequent comorbidity.
- Surgical treatment shows significantly lower inpatient mortality (12.2%) compared to medical management (47.8%).
Conclusions:
- Aortic root pseudoaneurysms are most common in middle-aged males, often with a history of prior aortic procedures.
- Accurate diagnosis requires a combination of clinical history, transesophageal echocardiography, and CT aorta.
- Surgical intervention is the preferred therapeutic approach for aortic root pseudoaneurysms, leading to improved survival rates.
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