Plug Closure of an Ascending Aortic Graft Anastomotic Pseudoaneurysm After Mediastinitis

Ascending aortic pseudoaneurysms are rare but high-risk complications after cardiac surgery. Whereas open repair remains standard, transcatheter closure offers a less invasive option for high-risk patients. We report the case of a 50-year-old man in whom an ascending aortic graft anastomotic pseudoaneurysm developed 10 months after aortic valve and ascending aortic replacement complicated by mediastinitis. As redo surgery carried a significant risk, an Amplatzer vascular plug II was deployed across the anastomotic defect with a disk-to-disk configuration, achieving complete exclusion. Follow-up computed tomography at 3 and 6 months revealed progressive shrinkage of the pseudoaneurysm, supporting plug closure as a feasible alternative.