A Case of Redo Ascending Aortic Replacement for Anastomotic Pseudoaneurysm through Right Thoracotomy in a Patient with Severe Coagulation Disorder

Emi Nagata＊

Yoshiyuki Sato＊

Koki Takahashi＊

（Department of Cardiovascular Surgery，Ohta Nishinouchi Hospital＊，Koriyama，Japan）

A 51-year-old man presented to our hospital with general fatigue and lower extremity edema due to right heart failure with severe coagulation disorder. He had undergone ascending aortic and total arch replacement for type A acute aortic dissection when he was 49 years old and had diagnosed with anastomotic pseudoaneurysm in the ascending aorta by computed tomography 1 year after the operation. Preoperative computed tomography showed an enlargement of the pseudoaneurysm. Since re-median sternotomy seemed to be high risk strategy for bleeding due to severe coagulation disorder, we decided to perform ascending aortic replacement through right thoracotomy. We opened the pseudoaneurysm and found an aorto-right atrium fistula. Redo ascending aortic replacement with direct closure of the fistula was successfully performed. The postoperative course was uneventful.

 

Jpn. J. Cardiovasc. Surg. 51 : 163-166 （2022）

Keywords：anastomotic pseudoaneurysm ; right thoracotomy ; coagulation disorder ; aorto-right atrium fistula