Transcatheter Closure of an Ascending Aortic Pseudoaneurysm Guided by Intracardiac Echocardiography

A 60-year-old man with a history of multiple cardiac surgeries presented with exertional dyspnea. CT revealed a 20 × 10 mm ascending aortic pseudoaneurysm with a neck diameter of 7 mm, located near the suture line of a previous aortic root replacement, compressing a saphenous vein graft (SVG). Given the high risk of reoperation, percutaneous catheter closure with a 9/12 mm Amplatzer Vascular Plug II (AVP II) was performed alongside drug-eluting stent (4.0 × 18 mm) implantation to address SVG stenosis. Intraoperative intracardiac echocardiography (ICE) was essential for guiding AVP II deployment and ensuring accurate placement. This case highlights the effectiveness and safety of ICE-guided percutaneous interventions in managing complex aortic pathologies in high-risk patients. Successful closure of the pseudoaneurysm and resolution of the SVG compression demonstrated the feasibility of this minimally invasive approach in patients with complex surgical histories.