PMC5743124_01
Echocardiography study.. Notes: (A) Paraesternal long-axis view in systole with pseudoaneurysm at supra-annular level next to the right coronary sinus (white arrows) and (B) diastole with pseudoaneurysm (red arrows) and severe paraprosthetic aortic regurgitation (white arrows). (C) Paraesternal short axis view in diastole with pseudoaneurysm and RCA (yellow arrows) and (D) systole with pseudoaneurysm and RCA (green arrows).. Abbreviation: RCA, right coronary artery.
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A transthoracic echocardiography (TTE) was performed, and an image of an aortic pseudoaneurysm was detected in TTE (Figure 1A, C and D). A severe paraprosthetic aortic regurgitation was observed (Figure 1B), following which a 64-slice multidetector computed tomography (MDCT) was performed.
MDCT volume rendering image shows compression of the RCA by the aortic pseudoaneurysm (white arrow) and the saphenous venous bypass graft (yellow arrow).. Abbreviations: MDCT, multidetector computed tomography; RCA, right coronary artery.
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The presence of an aortic pseudoaneurysm originating from the right sinus of Valsalva was successfully shown in the volume rendering images (Figure 2).
Multidetector computed tomography study.. Notes: (A) The oblique reconstruction of the MDCT shows contrast enhancement and areas of thrombosis within the aortic pseudoaneurysm (red arrows). (B) Axial CT slice showing ascending aortic aneurysm and pseudoaneurysm of 59.1x65.1 mm up to the arch. (C) MDCT oblique reconstruction of aortic pseudoaneurysm. (D) MDCT oblique reconstruction with RCA and aortic pseudoaneurysm (yellow arrow). (E) Multiplanar reconstruction of saphenous venous bypass graft (yellow arrow). (F) MDCT oblique reconstruction of aortic prosthesis valve.. Abbreviations: MDCT, multidetector computed tomography; RCA, right coronary artery.
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In the MDCT axial views, the pseudoaneurysm was localized in the anterior wall of the thoracic aorta, showing contrast enhancement within it (Figure 3A and C), as well as an ascending aortic aneurysm, up to the aortic arch (Figure 3B). The MDCT revealed compression of the native right coronary artery (RCA) due to the pseudoaneurysm (Figure 3D), this being the cause for the probable ischemia in this area. The LCX had a chronic occlusion and the venous grafting was functioning properly (Figure 3E). MDCT oblique reconstruction also showed the aortic prosthesis valve (Figure 3F).