Pseudoaneurysm of the Ascending Aorta Following Bentall Proc
Aortic pseudoaneurysm (APA) is a rare but serious and complex complication of ascending aorta and/or aortic root prosthetic replacement which may lead to rupture and bleeding. APA following ascending aorta surgery is defined as a total or partial dehiscence of the vasular prosthesis from heart structures occurring after replacement of the ascending aorta. Although in the event of rupture, the mortality rate is high, patients often do not notice development of the pseuodaneurysm. If symptomatic, a pulsatile suprasternal mass, chest pain, dysphagia, and stridor may appear. The incidence is not wellknown nor risk factors or the natural history of aortic pseudoaneurysm. The mechanisms of APA formation are also unclear though suture line under tension or infectious endocarditis is presumed. APA develops late, usually years after operation. APA usually rupture, hence prompt surgical intervention is necessary.

Case Report
The 42 years old caucasian man suffered acute aortic dissection type A and Bentall procedure with mechanical valve conduit (SJM graft prosthesis 25 mm) was performed. Remaining aorta tissue and the suture lines were reinforced by tissue glue (BioGlue®, CryoLife). The postoperative course was complicated by a recurrent fever of unknown etiology (completely negative laboratory tests). Infective endocarditis was considered, tha antibiotic therapy was administered. The transoesophageal echocardiography (TOE) was performed and revealed a collection of fluid surrounding the aortic graft with a tendency to progression (Figure 1)....