Copyright © Italian Federation of Cardiology. Unauthorized reproduction of this article is prohibited. Conservative management of the pseudoaneurysms of ascending aortic graft: a case of spontaneous regression at follow-up Marco Agrifoglio a , Gianluca Pontone a , Daniele Andreini a , Paolo Biglioli a , Faisal H. Cheema b and Fabio Barili b,c Pseudoaneurysms of thoracic aorta represent life-threatening complications of cardiac surgery. We present a case report of a patient who underwent urgent aortic valvular replacement with a biological prosthesis and ascending aortic replacement with graft interposition and developed postoperative ascending aortic pseudoaneurysms. The pseudoaneurysms did not increase in the postoperative stay and a conservative management was chosen. At follow-up, the two pseudoaneurysms had completely regressed. The therapeutic steps for aortic pseudoaneurysms should be tailored to the patient and even conservative management could be effective if selected after an evaluation of the clinical status of the patient. J Cardiovasc Med 2011, 12:586–588 Keywords: aortic pseudoaneurysm, cardiac surgery, multislice computed tomography a Department of Cardiovascular Surgery, Centro Cardiologico Monzino, University of Milan, Milan, Italy, b Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, New York, USA and c Department of Cardiovascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy Correspondence to Fabio Barili, MD, PhD, Department of Cardiovascular Surgery, S. Croce e Carle Hospital, via M. Coppino 26, 12100 Cuneo, Italy Tel: +39 0171642571; fax: +39 0171642064; e-mail: fabarili@libero.it fabio.barili@gmail.com Received 17 February 2011 Revised 21 March 2011 Accepted 30 March 2011 A 62-year-old woman was admitted to our department for acute aortic type A dissection and severe aortic valvular regurgitation. Associated diseases were restrictive chronic obstructive pulmonary disease (COPD), chronic renal insufficiency and uncontrolled hypertension. The patient underwent urgent aortic valve replacement with bio- logical prosthesis and ascending aortic replacement with graft interposition. The postoperative course was characterized by pyrexia, leukocytosis and increased C-reactive protein with negative blood and urine cultures and without sternal wound involvement. Multislice computed tomography (MSCT) showed two aortic pseudoaneurysms at the level of the distal anastomosis of the vascular graft, close to the aortic root (Fig. 1a). An empirical antimicrobial therapy with intravenous broad-spectrum antibiotics was initiated, and the inflam- matory indexes rapidly normalized. The antimicrobial therapy was discontinued after 20 days. The patient was asymptomatic and a MSCT scan did not reveal a progression of the pseudoaneurysms. In consideration of the clinical and instrumental parameters, we opted for conservative management and a MSTC scan follow-up was planned. The patient was discharged on postopera- tive day 30. At 3-month follow-up, the MSCT showed the regression of the smaller pseudoaneurysm and a slight increase of the second one (Fig. 1b). The patient reported no symptoms and pyrexia and blood samples were normal. The general clinical status led to delay of surgery and to strictly control blood pressure. At 6-month follow-up, even the second pseudoaneurysm had completely regressed (Fig. 1c). Postoperative pseudoaneurysms of the ascending aorta are uncommon complications of cardiac surgery, occur- ring in fewer than 5% of all cardiac operations. 1 They can be located at every surgical site and their risk factors include infections, intrinsic aortic wall disease, poor anastomotic technique and tissue necrosis due to abusive use of gelatin–resorcin–formol glue. Surgical treatment is considered the gold standard therapy and includes several different approaches. 1–4 However, although safe techniques were developed in the past de- cade, hospital mortality may reach 17–20% 5 and it should be considered when the timing of the surgery is planned. The conservative management of pseudoaneurysms of the ascending thoracic aorta is often avoided, especially if Images in cardiovascular medicine 1558-2027 ß 2011 Italian Federation of Cardiology DOI:10.2459/JCM.0b013e3283474e71