dehiscence of a composite aortic graft and pseudoan- eursym late after a bentall operation

a 32-year-old female patient with previous bentall operation and mitral valve repair surgery due to severe aortic insufficiency, mitral valve insufficiency, and ascending aortic aneurysm was admitted to our hospital with serious dyspnea, fatigue, and mild chest pain. two-dimensional echocardiography demonstrated a markedly dilated basal aorta and cardiac chambers. thoracic computed tomography scan highlighted a pseudoaneurysm, 14.5 cm in diameter (figure 1). urgent surgery was planned. the operation was performed under deep hypothermic cardiopulmonary bypass (arterial and venous line in the right femoral artery and vein). a large aortic pseudoaneurysm was demonstrated arising from the dehiscence of the proximal graft anastomosis (figure 2). the composite graft did not require replacement, and it was possible to simply re-suture the composite graft and directly close the tear. the postoperative course was uneventful with no further evidence of leak from the anastomotic sites.