Giant Ascending Aortic Pseudoaneurysm With Sternal Erosion: A Complex Case Eight Years Post-Aortic Surgery

Abstract

Background: Aortic pseudoaneurysms are a rare but potentially life-threatening complication that can occur following cardiac or aortic root surgery, with an incidence of less than 1%. These pseudoaneurysms are typically contained only by the adventitia and surrounding mediastinal structures, and surgical intervention becomes particularly challenging when erosion of nearby bony structures occurs. Case Summary: We present the case of a 74-year-old woman who developed a giant pseudoaneurysm of the ascending aorta eight years after undergoing aortic valve and ascending aorta replacement. This pseudoaneurysm subsequently led to sternal and bony erosion, creating additional management challenges. Multimodal imaging, including contrastenhanced computed tomography (CT), magnetic resonance imaging (MRI), and transthoracic echocardiography (TTE), was utilized to assess pseudoaneurysm morphology and its relationship with surrounding structures. The decision of using an open graft replacement with cardiopulmonary bypass (CPB) was based on the lesion’s size, its proximity to vital structures, and the presence of significant sternal erosion. The patient underwent urgent surgical intervention involving CPB and replacement of the infected graft, resulting in an uneventful recovery. Follow-up at 18 months confirmed stability, with no evidence of recurrence. Conclusions: Giant ascending aortic pseudoaneurysms that exhibit rapid growth and cause bony erosion present significant surgical challenges. Early recognition, multimodal imaging, and tailored surgical strategies are essential for optimal outcomes. Long-term surveillance is crucial in preventing delayed complications.