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Anastomotic pseudoaneurysm leading to acute tamponade following autograft replacement of the aortic valve
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Pseudoaneurysm is a rare complication of cardiac surgery. The most common predisposing factors are left or right ventriculotomy, placement of a conduit or a right ventricular outflow tract patch, and vascular bypass procedures. The material used, suture technique, infection, progressive vascular disease, poor viability of the structure bordering the graft, and elevated pressure at the anastomosis site are all considered to be responsible in the aetiology of the condition. Echocardiography provides excellent diagnostic information and helps to differentiate between abscess or true aneurysm formation. Early diagnosis is essential if life threatening complications such as infection, embolism, compression of the surrounding structures or rupture leading to tamponade are to be avoided.

The illustrations show a routine echocardiogram recorded eight days after autograft replacement of the aortic valve in a 12 year old boy who underwent surgery because of congenital aortic regurgitation. In parasternal short axis view (left) a pseudoaneurysm (An) is visible adjacent to the aortic root (Ao). The communication of the false aneurysm with the left ventricular outflow tract is clearly seen with Doppler colour flow examination (right) from the same view (RA, right atrium; RV, right ventricle; PA, pulmonary artery).

A few hours after the diagnosis the child developed acute tamponade and collapsed because of rupture of the false aneurysm into the pericardial space. At emergency surgery the aortic suture line was found to have partially dehisced. This was resutured and the patient made a rapid and uncomplicated recovery.