Aortic Valve Stenosis-Like Symptoms Caused by Pseudoaneurysm Following Total Arch Replacement

Although postoperative ascending aortic pseudoaneurysm is a life-threatening complication, it has not been reported to present with symptoms similar to aortic stenosis or lead to cardiac arrest due to intravascular pressure effects.^1,2

A 70-year-old man who had undergone total arch replacement for aortic dissection 3 years earlier presented with symptoms of presyncope. He was admitted to hospital for a comprehensive examination, and shortly thereafter, experienced cardiac arrest. Cardiopulmonary resuscitation was successfully performed. Cardiac CT scan performed upon admission ruled out the presence of coronary artery disease, but identified a pseudoaneurysm at the central anastomosis of the ascending aorta, which appeared to be exerting external compression on the vascular graft of the ascending aorta (Figure A, Supplementary Movie 1). Contrast CT scan revealed vascular graft stenosis above the sinus of Valsalva (Figure B, Supplementary Movie 2). Figure C shows the position of the pseudoaneurysm and the vascular graft in the reconstructed images. A significant systolic pressure gradient (>60 mmHg) was measured between the sinus of Valsalva and the ascending aortic graft (Figure D), comparable to very severe aortic stenosis. This finding supported the conclusion that the patient’s symptoms were due to graft compression by the pseudoaneurysm. Despite the implementation of mechanical cardiopulmonary support for cardiogenic shock, the patient died of cerebral ischemia.

Figure.

(A) 3D CT image showing vascular graft (white arrow) and the pseudoaneurysm (red arrow). (B) Contrast CT scan shows stenosis of the vascular graft (white arrow) above the sinus of Valsalva. The red arrow indicates the pseudoaneurysm. (C) Reconstructed images show the position of the pseudoaneurysm (orange) and the vascular graft. (D) Significant systolic pressure gradient (>60 mmHg) measured between the sinus of Valsalva and the ascending aortic graft.

Acknowledgment

We thank the staff of the Department of Cardiology and Cardiovascular Surgery, Oita University.

Disclosures

All authors declare no conflicts of interest.

Ethical Statement

Not required for reporting individual cases or case series.

Supplementary Files

Supplementary Movie 1

Supplementary Movie 2

Please find supplementary file(s);

https://doi.org/10.1253/circj.CJ-24-0918

References

• 1.   Nakamura K, Otsuka Y, Komaki T, Okonogi T, Noguchi H, Higa T, et al. Pseudoaneurysm of the ascending aorta with perforation into the left atrium presenting as acute heart failure. Circ J 2012; 76: 2283–2284.
• 2.   Espinosa-Caliani JS, Montijano A, Melero JM, Montiel A. Pseudoaneurysm in the mitral-aortic intervalvular fibrosa: A cause of mitral regurgitation. Eur J Cardiothorac Surg 2000; 17: 757–759.