Metabolic Syndrome: Stronger association With Coronary Artery

Arch Iranian Med 2006; 9 (4): 429 – 432
Case Report
Results of the Repair of Aortic False Aneurysm
Seyed-Hossein Ahmadi MD*, Nader Movahed MD*, Kioumars Abbasi MD*,
Hassan Soltaninia MD*, Ali-Reza Amirzadegan MD**, Mehdi Najafi MD*,
Shapoor Shirani MD***, Mehrab Marzban MD*, Abbas-Ali Karimi MD*,
Seyed-Jalil Mirhoseini MD*, Mehdi Sanatkarfar MD • *
Aortic false aneurysm is a rare complication of surgery of the aorta that can occur several
months to years after the initial operation. We reviewed our results with false aneurysm repair
using deep hypothermia and circulatory arrest.
Three patients were reoperated for false aneurysm of the ascending aorta. Femorofemoral
cardiopulmonary bypass with a heparinized system was used in all patients. Hypothermic
circulatory arrest at an average temperature of 20°C was instituted in all patients for repair. Two
patients had a patch repair with pericardium, and the other one had primary repair of the defect.
All patients had false aneurysms in the ascending aorta at the site of a previous aortotomy. Two
patients had proven infection as the cause. The mean cardiopulmonary bypass time was 183 ± 20
minutes, and the mean circulatory arrest time was 35 minutes. Operative mortality was not seen.
The mean time for extubation in survivors was 10 – 12 hours, and the average time to discharge
was 26 days.
Aortic false aneurysms can be safely approached using femorofemoral cardiopulmonary
bypass, hypothermic circulatory arrest, and patch repair with acceptable operative mortality and
long-term survival.
Archives of Iranian Medicine, Volume 9, Number 4, 2006: 429 – 432.
Keywords: Ascending thoracic aorta cardiopulmonary bypass false aneurysm
Introduction
Aortic false aneurysms are rare
complication of surgical manipulation
of the aorta occurring in less than 0.5%
of the patients undergoing cardiac surgery. 1
Numerous etiologic entities have been associated
with this complication such as patch repair of
coarctation of the aorta, graft infection or
mediastinitis, poor anastomotic techniques, and
poor aortic wall tissue. 1 – 3 Aortic pseudoaneurysms
or false aneurysms are the result of disruption of at
least one layer of the wall of the vessel and
Authors’ affiliations: *Department of Cardiovascular surgery,
**Department of Cardiology, ***Department of Radiology,
Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran.
•Corresponding author and reprints: Mehdi Sanatkarfar MD,
Department of Cardiovascular Surgery, Imam Khomeini Hospital,
Keshavarz Blvd., Tehran, Iran.
Fax: +98-21-692-9977,
E-mail: a3094@sina.tums.ac.ir.
Accepted for publication: 6 November 2006
contained the remaining vascular layers supported
by the surrounding structures of the mediastinum.
Pseudoaneurysm of the ascending aorta can present
as a pulsatile suprasternal mass, evidence of
myocardial ischemia as a result of compression of
coronary artery bypass grafts, dysphagia, and
stridor. Patients usually present with general
symptoms of fatigue and weight loss.
The approach to these patients depends on the
site and size of the false aneurysm. Numerous
reports have been published about the repair of
aortic false aneurysm in the abdominal aorta, but
very few studies have reported the successful
repair of the thoracic aorta. 4 We describe our
results of surgical repair of false aneurysm of the
thoracic aorta using cardiopulmonary bypass
(CPB), deep hypothermia, and circulatory arrest.
Case Report
Three patients were retrospectively reviewed
for reoperations for false aneurysm of the
Archives of Iranian Medicine, Volume 9, Number 4, October 2006 429