PMC7452561_01
Preoperative coronarography: (A) Coronary angiogram (CAG) shows 70% stenosis in the distal segment of the RCA, (B) Coronary angiogram (CAG) shows 75% stenosis of the the distal segment of the LAD, 80% and 75% stenosis, respectively in the mid and distal segments of the LCx, (CAG - coronary angiogram, LAD - left anterior descending coronary artery, RCA - right coronary artery, LCx - left circumflex coronary artery).
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Coronary angiography (CAG) showed left dominant coronary system with triple vessel coronary disease: 75% stenosis of the distal segment of left anterior descending coronary artery (LAD), left circumflex coronary artery (LCx) in the mid and distal segments had stenosis of 80% and 70%, respectively, and 70% stenosis of distal segment of the right coronary artery (RCA) (Fig. 1).
Preoperative contrast enhanced CT scan: (A) CT scan showing the AAP at the level of the aortic arch, (B) 3D CT-scan showing the AAP, with the neck present just caudally from LSA on the lesser aortic arch curvature. (AAP - aortic arch pseudoaneurysm, LSA - left subclavian artery).
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Apart from the complex lesions of the coronary arteries, 3D CT-scan revealed an AAP, with the neck present just caudally from the left subclavian artery (LSA) on the lesser aortic arch curvature which had a maximum diameter of 36 x 27 mm (Fig. 2).
Intraoperator view of aortic arch with Dacron patch repair.
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The aorta was first cross-clamped immediately after the origin of the LCA and a second clamp at the level of the aortic isthmus allowing us to perform the repair of the pseudoaneurysm on beating heart (Fig. 3).
(A) RCA CAG poststenting, (B) LCx CAG poststenting. (CAG - coronary angiogram, RCA - right coronary artery, LCx - left circumflex coronary artery).
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After weaning of CPB the PCI with DES was performed for the RCA, and LCx lesions (Fig. 4).
Multislice 3D reconstruction CT scan of the aortic arch after three months showing no evidence of filling or enlargement of the AAP. (AAP- aortic arch pseudoaneurysm).
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At three months after this procedure, a follow-up CT scan with 3D reconstruction was performed and revealed an excellent result, without residual arch pseudoaneurysm (Fig. 5).