Pravinthiran Manokaran, Sivakumar Krishnasamy, Raja Rizal Azman Bin Raja Aman, Victoria Wen Yeng Teoh, Alexander Loch
{"title":"Aortic root pseudoaneurysm: a case report and literature review.","authors":"Pravinthiran Manokaran, Sivakumar Krishnasamy, Raja Rizal Azman Bin Raja Aman, Victoria Wen Yeng Teoh, Alexander Loch","doi":"10.1007/s12055-023-01580-x","DOIUrl":null,"url":null,"abstract":"<p><p>Pseudoaneurysms of the aortic root are rare. A case of prosthetic aortic valve infection progressing from a confined intramural abscess to a ruptured abscess communicating with the aorta and forming a large pseudoaneurysm is described. Additionally, data from all cases and case series, published between 2000 and 2021, was analyzed. A PUBMED search for the keywords \"aortic root mycotic aneurysm,\" \"aortic root abscess AND infective endocarditis,\" and \"aortic root mycotic aneurysm AND infective endocarditis\" yielded 152 publications (with 157 cases described): Aortic pseudoaneurysm is more common in males (80.9%, <i>n</i> = 127). Mean age is 51 years (4 months-84 years). The most common symptom is fever (68.5%, <i>n</i> = 102). Mean time until diagnosis is 27.2 days. Embolic complications are present in 17.8% (<i>n</i> = 28) at diagnosis. Most cases are due to valvular infections (<i>n</i> = 72 cases, 45.9%). Prior cardiac surgery is documented in 49.0% (<i>n</i> = 77). The mean time interval for developing aortic root abscess following heart surgery is 32.2 months. 22.3% (<i>n</i> = 35) are immunocompromised. Aetiological agents were <i>Staphylococcus</i> sp. (34.1%, <i>n</i> = 47) and <i>Streptococcus</i> sp. (23.2%, <i>n</i> = 32). Mean antimicrobial therapy lasts 58.5 days. Outcome with surgery is superior to medical treatment: overall inpatient mortality 18.5% (<i>n</i> = 27); with surgery 12.2% (<i>n</i> = 15 out of 123 patients), with only medical management 47.8% (<i>n</i> = 11 out of 23 patients). In conclusion, aortic root pseudoaneurysm occurs most commonly in middle-aged male patients. History of prior aortic procedures is commonly present. Correct diagnosis hinges on detailed history, transoesophageal echocardiography, and computed tomography (CT) aorta. Surgery is the preferred therapeutic option.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-023-01580-x.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.7000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10728390/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12055-023-01580-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/8/29 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Pseudoaneurysms of the aortic root are rare. A case of prosthetic aortic valve infection progressing from a confined intramural abscess to a ruptured abscess communicating with the aorta and forming a large pseudoaneurysm is described. Additionally, data from all cases and case series, published between 2000 and 2021, was analyzed. A PUBMED search for the keywords "aortic root mycotic aneurysm," "aortic root abscess AND infective endocarditis," and "aortic root mycotic aneurysm AND infective endocarditis" yielded 152 publications (with 157 cases described): Aortic pseudoaneurysm is more common in males (80.9%, n = 127). Mean age is 51 years (4 months-84 years). The most common symptom is fever (68.5%, n = 102). Mean time until diagnosis is 27.2 days. Embolic complications are present in 17.8% (n = 28) at diagnosis. Most cases are due to valvular infections (n = 72 cases, 45.9%). Prior cardiac surgery is documented in 49.0% (n = 77). The mean time interval for developing aortic root abscess following heart surgery is 32.2 months. 22.3% (n = 35) are immunocompromised. Aetiological agents were Staphylococcus sp. (34.1%, n = 47) and Streptococcus sp. (23.2%, n = 32). Mean antimicrobial therapy lasts 58.5 days. Outcome with surgery is superior to medical treatment: overall inpatient mortality 18.5% (n = 27); with surgery 12.2% (n = 15 out of 123 patients), with only medical management 47.8% (n = 11 out of 23 patients). In conclusion, aortic root pseudoaneurysm occurs most commonly in middle-aged male patients. History of prior aortic procedures is commonly present. Correct diagnosis hinges on detailed history, transoesophageal echocardiography, and computed tomography (CT) aorta. Surgery is the preferred therapeutic option.
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-023-01580-x.
期刊介绍:
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.