Author + information
- Received May 17, 2018
- Revision received May 25, 2018
- Accepted May 29, 2018
- Published online August 1, 2018.
- Olga Toscano, MD,
- Marco Bergonti, MD,
- Giovanni Teruzzi, MD∗ ( and )
- Daniela Trabattoni, MD
- ↵∗Address for correspondence:
Dr. Giovanni Teruzzi, Centro Cardiologico Monzino, IRCCS, Via Parea, 4–20138 Milan, Italy.
- aortic arch replacement
- covered stent
- left internal mammary pseudoaneurysm
- pulmonary hypertension
A 73-year-old man was referred to our clinic because of increasing fatigue, shortness of breath, and new-onset pulmonary hypertension (pulmonary artery pressure 73 mm Hg). Echocardiography and thoracic computed tomography scan showed a 75 × 67-mm mediastinal blood thickening with diffuse luminal thrombosis compressing the right ventricular outflow tract but without any connection with it or the pulmonary system. This finding, right ahead the ascending aorta and actively supplied by the left internal mammary artery, was initially diagnosed as a pseudoaneurysm either of the aortic arch or of the left mammary artery itself (Figure 1).
The patient was known for 2 previous surgical replacements of the ascending aorta and aortic arch due to aortic aneurysms in 1997 and 2017.
After heart team discussion, angiography performed through left radial access confirmed the presence of a giant pseudoaneurysm of the left mammary artery, in the middle segment of the vessel, right above a stenotic kinking segment. The stenotic tract was pre-dilated with a noncompliant balloon, then a covered stent (3 × 26 mm) was placed right above the leaking point. Immediately after the procedure, no further pseudoaneurysm filling was detectable (Figure 1).
This case developed a giant mammary artery pseudoaneurysm following aortic arch and ascending aorta surgery. No certain cause for this patient scenario was found. However, we suppose accidental damage to the external wall of the vessel occurred during surgery, leading to the increasing growth of the aforementioned mediastinal blood thickening and thus causing left ventricular outflow tract compression, volume overload, and an increase in pulmonary pressure values.
- Received May 17, 2018.
- Revision received May 25, 2018.
- Accepted May 29, 2018.
- 2018 American College of Cardiology Foundation