Discussion
Endovascular technologies are increasingly available to clinicians as
options for minimally invasive approaches to complex pathologies
[2–6]. While an anastomotic pseudoaneurysm following aortic root
replacement is a rare sequela, it poses a challenge given the added
morbidity and potential mortality of a reoperative sternotomy [7,8].
The AmplatzerTM Septal Occluder has been previously
used in a limited fashion for percutaneous closure of aortic
pseudoaneurysms in 13 cases, of whom only two had prior aortic root
replacements [5,6]. While there is some evidence that transcatheter
approaches may not be effective, we present a clinical scenario of a
postoperative pseudoaneurysm arising from the left ventricular outflow
tract (LVOT) of a patient who had previously undergone a composite root
replacement [3]. Given the morbidity and potential mortality of an
open repair, the patient underwent a successful percutaneous
transcatheter repair with radiographic resolution seen two years
following the intervention. This case adds to recent literature
suggesting that alternative techniques to open repair may be safe and
durable for the salvage of composite root replacements with
pseudoaneurysmal complications. While the transcatheter repair has been
limited to patients who are truly not operative candidates, it can be a
useful tool to employ depending upon the resources available to the
clinician and preferences of the patient.