A poor outcome after surgical aortic replacement.

Pseudoaneurysm formation after aortic valve and root replacement is a postoperative complication that has traditionally been addressed by surgical means. We describe a case of a large subaortic pseudoaneurysm successfully occluded by transcatheter device closure. A 64-year-old woman with a history of mitral valve repair and ring implantation due to severe valvular regurgitation was referred for surgical aortic valve replacement due to symptomatic severe aortic valve stenosis and dilated aorta. The postoperative period was complicated by refractory shock, and exploratory surgery revealed a cardiac rupture around the aortic valve, followed by annulus repair and implantation of a new bioprosthetic valve. Echocardiography subsequently showed a persistent cardiac communication with to-and-fro flow and a large pericardial effusion. The computed tomography angiogram (Figure 1A and B) revealed a large fluid collection compressing the pulmonary artery and left atrium. The case was discussed at a meeting of the multidisciplinary heart team, in which cardiac surgeons discouraged an additional (fourth) surgical attempt.