Aortic Pseudoaneurysm Causing Compression of the Left Main Coronary Artery

J INVASIVE CARDIOL 2018;30(10):E103-E104.

Key words: aortography, cardiac imaging, computed tomography

A 75-year-old man with a history of mechanical aortic valve replacement (AVR) with aortic conduit for severe aortic insufficiency underwent routine computed tomography (CT) evaluation revealing right coronary anastomosis endoleak and proximal aortic root pseudoaneurysm. The aortic dilation had been identified after the index surgery and was serially monitored. However, the follow-up CT scan revealed accelerated dilation with a 0.5 cm enlargement in 6 months. CT chest revealed close proximity of the aortic pseudoaneurysm with the ostium of the left main coronary artery (LMCA) resulting in intermittent compression (Figures 1A and 1B). Transthoracic echocardiography (TTE) revealed flow within an outpouching surrounding the proximal aortic root consistent with pseudoaneurysm. Pre-repair coronary angiography showed intermittent compression of the LMCA (Figures 2 and 3; Videos 1 and 2). The patient subsequently underwent bioprosthetic aortic valve repair with aortic conduit and re-implantation of the right and left coronary arteries due to dehiscence of the mechanical aortic valve (Figures 1C and 1D). Postoperative angiography demonstrated resolution of the aortic pseudoaneurysm and the associated LMCA compression.

From the ¹Department of Cardiology, ²Department of Cardiothoracic Surgery, and ³Department of Radiology, Zucker School of Medicine at Hofstra Northwell, North Shore University Hospital, Manhasset, New York.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted April 13, 2018. 

Address for correspondence: Michael P. Gannon, MD, 300 Community Drive, Manhasset, NY 11030. Email: gannonmg@gmail.com