Acute presentation of aortic pseudoaneurysm as a late complication of previous cardiac surgery: a case report.

BACKGROUND

Pseudoaneurysms of the ascending aorta are a rare but life-threatening complication of cardiac surgery, often occurring years after the initial procedure. They may remain asymptomatic or present acutely with rupture, leading to cardiac tamponade or sudden death.

CASE SUMMARY: An 84-year-old female, with a history of biological aortic valve replacement 15 years prior, presented with acute chest pain radiating to the back. She was hypotensive and exhibited signs of shock. Transthoracic echocardiography revealed a large, heterogeneous pericardial effusion with right heart chamber collapse. Contrast-enhanced computed tomography showed a large pseudoaneurysm originating at the previous aortotomy site, extending inferiorly and compressing the right atrium. Given the clinical status, urgent surgery was performed, under femoro-femoral cardiopulmonary bypass initiated before re-sternotomy. A large haematoma surrounding the heart and major vessels required meticulous dissection, and a 2 cm rupture at the previous aortotomy site was successfully repaired using a supracoronary graft. The patient had an uneventful recovery and was discharged on the ninth day post-op.

CONCLUSION

Late-onset aortic pseudoaneurysm is a rare but life-threatening complication of cardiac surgery. High clinical suspicion, timely imaging, and prompt surgical intervention are essential to prevent fatal outcomes.