Surgical Management of Infectious Pseudoaneurysm of the Ascending Aorta Post Coronary Artery Bypass Grafting: A Rare Clinical Condition

Abbasi Tashnizi, Mohammad; Moeinipour, Aliasghar; Zirak, Nahid; Ghorbanzadeh, Atefeh; Manafi, Babak; Roohi Golkhatmi, Mohammad Ali; Sheybani, Shima

Surgical Management of Infectious Pseudoaneurysm of the Ascending Aorta Post Coronary Artery Bypass Grafting: A Rare Clinical Condition

Authors

Mohammad Abbasi Tashnizi ¹

Aliasghar Moeinipour ¹

Nahid Zirak ²

Atefeh Ghorbanzadeh ³

Babak Manafi ⁴

Mohammad Ali Roohi Golkhatmi ⁵

Shima Sheybani ⁶

¹ Department of Cardiac Surgery, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, I.R. Iran.

² Department of Anesthesiology, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad,I.R.Iran

³ Faculty of Medicine, Mashhad University of MedicalSciences, Mashhad, I.R. Iran

⁴ Faculty of Medicine, HamadanUniversity of Medical Sciences, I.R.Iran.

⁵ Department of Cardiac Surgery, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, I.R.Iran.

⁶ Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad,I.R.Iran.

Abstract

Background: Although an extremely rare clinical condition, the pseudoaneurysm of a saphenous vein graft the ascending aorta may occur several months following coronary artery bypass graft surgery. Methods: This paper describes a 48-year-old male patient with a history of addiction, who underwent coronary artery bypass graft surgery. The patient was referred to the emergency department 20 days after his surgery with a number of symptoms such as fever, weakness, tachycardia, tachypnea, zero Richmond Agitation Sedation Scale )RASS(, and low hemoglobin level. He was then admitted for a sepsis workup. A combined regimen of ciprofloxacin, vancomycin, and meropenem was prescribed after a positive Pseudomonas aeruginosa blood culture. Results: Computed tomography angiography showed a pseudoaneurysm in the upper and anterior mediastinum. Reoperation was planned for surgical removal, followed by right femoral arterial, venous cannulation and deep hypothermic circulatory arrest (18–20 °C), all of which yielded a favorable outcome. Conclusions: Rapid and accurate diagnosis and surgical correction are life-saving for pseudoaneurysms of the ascending aorta post coronary artery bypass graft surgery. (Iranian Heart Journal 2017; 18(2):53-57)

Keywords

Coronary artery bypass graft surgery

Pseudoaneurysm of aorta

Saphenous vein graft

Reoperation