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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
PubMed

Insights

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.
Keywords:
Aortic root abscessAortic root pseudoaneurysmInfective endocarditisProsthetic valve

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