PMC7287379_01
Pre-operative three dimensional computed tomography shows a pseudoaneurysm of the proximal descending thoracic aorta and shows that the aortic arch is hypoplastic and severely kinked.
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In April 2014, enhanced computed tomography angiography (CTA) revealed a pseudoaneurysm at the site of the previous CoA patch repair (Fig. 1). The aortic arch was hypoplastic, only 15 mm in diameter at the narrowest part, and severely kinked (Fig. 1).
Intra-operative angiography shows that Amplatzer vascular plugs (AVPs) have been deployed between the left subclavian artery and the proximal descending thoracic aorta. Coils are also deployed to fill the gap between the AVPs. There is no evidence of anastomotic stenosis of the ascending to descending aortic bypass or the graft to left axillary artery bypass.
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Additionally, Penumbra coils (Medicos-Hirata, Tokyo, Japan) and 0.035 inch diameter Nester coils (Cook Medical, Bloomington, IN, USA) were deployed to fill the gap between the AVPs to exclude the pseudoaneurysm (Fig. 2).
(A) Post-operative three dimensional computed tomography (CT) shows that the sac of the pseudoaneurysm has thrombosed. The two bypasses are patent without evidence of anastomotic stenosis. (B) CT performed three years after the operation shows that the aneurysm sac had shrunk completely.
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Post-operative enhanced CTA revealed that the sac of the pseudoaneurysm was completely thrombosed (Fig. 3A). Enhanced CTA performed three years post-operatively revealed that the aneurysm sac had shrunk completely (Fig. 3B).