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Pseudo Aneurysm of Ascending Aorta is operated on 17years/male. Previous surgery done is : VSD Closure + RVOT Obstruction relief + Trans-annular patch repair of RVOT For DCRV. Pseudo Aneurysm of Ascending Aorta was Eroding from sternum went on Femoro femoral bypass,Left anterolateral thoracotomy for LV – apical vent placement.20fr fem arterial, 25fr fem venous was used and patient Cooled to 20 degrees. Incidence of Pseudo Aneurysm of Ascending Aorta is < 0.5%. Aortic cannulation site,Aortic suture line,CABG insertion site,Infection are the causes.
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Experience on Pseudo Aneurysm of Ascending Aorta
G V Ramesh Reddy, Senior Clinical Perfusionist.Narayana Hrudayalaya Hospital, Hyderabad.
Age/sex : 17years/male.
Previous surgery : 23/11/10.
Surgery done : VSD Closure + RVOT Obstruction relief + Trans-annular patch repair of RVOT For DCRV.
Re - Admission : 16/11/11.
Pulsatile swelling over sternum.
Initially small, gradually increasing in size.
Eroding from sternum.
Leaking for last two hours.
High blood pressure.
CT Scan.
Routine Investigation.
Emergency repair of Aortic aneurysm Surgery
: 22/11/11.
Femoro femoral bypass.
Left anterolateral
thoracotomy for LV – apical vent placement.
20fr fem arterial, 25fr fem venous.
Cooled to 20oC.
Sternotomy , 1.5 x 2cms rent in the aorta.
Bovine pericardium + gore-tex patch combination.
23min low flows, 20min TCA.
Re warming ,de airing, weaning off CPB.
Total CPB time : 140min.
Fem artery , vein are repaired chest closed shifted to ICU.
Rent in the aorta
Extubated after 12 hours.
Rest postoperative course uneventful.
Discharged 14 day postoperatively.
DISCUSSION Pseudo aneurysm of ascending aorta is rare
complication after cardiac surgery.
Incidence < 0.5%.
High morbidity and mortality(29% - 46%).
Careful preoperative planning.
CPB……?????????? Axillary, femoral, or carotid.
CausesAortic cannulation site.
Aortic suture line.
CABG insertion site.
Infection.
Chest entry is a challenge
Proper technique to avoid blood loss & adequate cerebral perfusion.
Femoral or axillary arterial cannulation suggested.
Carotid cannulation ----- cerebral perfusion.
Suggested left side vent for decompression of LV, but does not guarantee in Sev AR.
Endovascular repair with septal occluder device.
DHCA
Sudden and extreme blood loss can be avoided.
preservation of cerebral function.
provides time.
The surgeon's decision to institute axillary, femoral, or carotid CPB should depend on the nature of each case.
THANK ‘U’
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