Ascending Aortic Pseudoaneurysm Fistulating into Right Atriu
A 54-year-old man presented with a large pseudoaneurysm (7.6 cm×6.4 cm) of the proximal ascending aorta after undergoing an aortic valve replacement for bicuspid aortic valve disease. The patient complained of shortness of breath and fatigue. The patient was taken to the operating room for repair. Intraoperative transesophageal echocardiography (TEE) demonstrated a contained transmural rupture of the ascending aortic wall with continuous flow jets from the aortic lumen toward the pseudoaneurysm in the upper esophageal ascending aortic short-axis view. An organized thrombus was also identified in the posterior aspect of the pseudoaneurysm. With the multiplane angle rotated to 62°, an aberrant high-velocity jet into the right atrium through a fistula arising from the pseudoaneurysm was observed. Bicaval venous cannulation for the cardiopulmonary bypass was used as a result. Direct inspection during surgery confirmed that the pseudoaneurysm developed at the aortic cannulation site used for the original aortic valve replacement. The fistula was located on the roof of the right atrium.