Internal thoracic artery pseudoaneurysm after redo aortic root replacement.

Pseudoaneurysm of the internal thoracic artery (ITA) or bleeding from the ITA is an extremely rare complication after cardiovascular surgery via a median sternotomy. Early treatment is needed in the case of massive haemorrhage or a rapidly enlarging pseudoaneurysm. Herein, we present a rare case of a delayed large pseudoaneurysm of the right ITA in a 49-year-old woman with Marfan syndrome who underwent redo aortic root replacement via re-median sternotomy and pacemaker implantation. Diagnostic selective angiography revealed the origin of the pseudoaneurysm, and simultaneous transcatheter embolisation of the ITA was successfully performed. Follow-up computed tomography imaging showed no evidence of contrast media extravasation from the ITA and recurrent extra-pleural haemorrhage. Our findings suggest that postoperative management of patients who have undergone median sternotomy, including cardiovascular surgeries, should also focus on the prevention or early detection of pseudoaneurysm of the ITA to avoid life-threatening conditions.