Percutaneous closure of an giant pseudoaneurysm leak of ascending aorta

1. XII Congreso Nacional de Cardiología
XXXIII Jornada SOLACI

2. Percutaneous Closure of an Giant
Pseudoaneurysm Leak of Ascending Aorta
Dr. Mauricio Vanegas,Dr.Fernandez Acuña,Dr.Saenz Madrigal,
Dr.Vladimir Putvinsky
Interventional Cardiology Unit
Hospital Calderon Guardia, CCSS.
San José, Costa Rica .

3. Potential conflicts of interest
Speaker's name: Mauricio Vanegas
 I do not have any potential conflict of interest

4. Case Study
• 72 years old female, with past history of
,severe Aortic Stenosis with HF Class II- III ,
NYHA. With preserved EF. Admmitted at the
hospital by Emergency Room .
• Previous history of Hypertension and
Hypotiroidism.
• A week later ,the patient had Aortic valve
replacement with biologic valve. SJ Epic # 19 .
• 7 days after Surgery, the patient had a
Septic Shock, Nosocomial Pneumonia and
dehicensia of wound . Had multiples surgical
scrubs . Spent 38 days at Intensive Care Unit.
• The patient was discharged after 47 days .
• Readmission 2 months later with a new
chest murmur and fever.
• New ECHO showed Subacute Endocarditis
( Staf Aureus Methicillin sensitive). The
patient completed 4 weeks of antibiotics.
• Chest X ray with wide mediastinum .
• Chest CT scan: Giant Pseudoaneurism of
the Ascending Aorta. Of 79 x 105.6 x 66.3
mm.

5. Case Study
Giant Pseudoaneurism 79mm x , 105.6mm x 66.3 mm. Very close proximity to Brachiocephalic Artery .

6. Case Study
Giant Pseudoaneurism 79mm x , 105.6mm x 66.3 mm
Very close proximity to Brachiocephalic Artery .

7. Heart Team
Heart team consensus
• Very high risk for second open thoracic
surgery.
• Consensus for a Percutaneous closure with
ASD device due to proximity to
Brachicephalic artery .
• Selected device : PFM Medical Nit/Occlud
ASD –R # 18 due to: : Flexible and adaptive
design
• Single-wire knit, Very low-profile
• Reduction metal of around 50%,
• LA polyester face accelerating
endothelialisation, Pre-mounted systems and
simple to release
• Easy to reposition and to retrieve
• Radiopaque, MR conditional ).
Nit/Occlud ASD device

8. Percutaneous Strategy
Procedure
• Arterial Access: 8 F introductor, Right
Femoral artery : for 6F Pig Tail and IVUS
Volcano vascular catheter confirming
diameter of the neck.
• 11 F introductor left femoral artery for 10 F
Sheath transportation to the pouch.
• ASD PFM 16mm was to small with risk of
embolization.
• ASD PFM 18 mm was successfully implanted.
• Closure of de artery acess with
Proglide device .
• The patient was discharged 3 days after the
procedure.

9. Procedure

10. Procedure

11. CT Scan2 months later

12. CT scan two momnths later

13. Conclusion
• Giant Pseudoaneurism of the Ascending Aorta is uncommon
complication after Aortic valve surgery.
• Percutaneous techniques are alternatives for patient with high risk for
a second surgery : Stent graft and coil implantation Injection of
thrombin into the pseudoaneurysm has been described .
• Few reports of successful closure with a percutaneous approach using
an occluder devices.
• CT scan is a very useful tools to determine size and importantly to fine
the right views during the delivery of the device.

14. MUCHAS
GRACIAS

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