Percutaneous plugging of an ascending aortic pseudoaneurysm.

F 76-year-old woman presented to hospital with a -month history of progressively worsening central hest pain. Her medical history was remarkable for previous aortic valve replacement with an ascendng aortic interposition graft 10 years earlier. A computed tomography (CT) scan showed a arge ascending aortic pseudoaneurysm with aortic ommunication through a defect at the superior spect of the structure, below the level of the nnominate vessels. Given the position of the seudoaneurysm, the risk of repeat sternotomy was hought too high. Furthermore, the abdominal orta was severely diseased and tortuous, making otential delivery of a covered stent difficult. It was herefore decided to attempt to close the mouth of he defect percutaneously. Vascular access was achieved via the right brahial artery, and aortography demonstrated modrate dehiscence at the posterior aspect of the uperior margin of the interposition graft (Fig. 1A, nline Video 1). Adjuvant intracardiac echocardigraphy (ICE) was performed with the imaging atheter in the superior vena cava and demontrated a leak from the true aortic lumen into the alse cavity (Fig. 1B). A 6-F Judkins right catheter as used with a 0.035-inch exchange length wire o enter the defect, and contrast injection through he catheter further defined the anatomy of the