PMC9646398_01
Preoperative transesophageal echocardiography demonstrating a paraaortic effusion (arrow) believed to be a paraaortic abscess formation.
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A transesophageal echocardiogram demonstrated an enlarged ascending aorta ( Fig. 1 ) possibly caused by a paraaortic abscess or a traumatic aortic injury.
Computed tomographic reconstruction of contained rupture of the ascending aorta approximately 5 cm above the aortic annulus (white arrow) and aneurysmatic ascending aorta distally (red arrow).
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Computed tomography showed a traumatic rupture of the ascending aorta 5 cm above the aortic valve ( Fig. 2 ). 
Multiple perforations of the aortic wall caused by the Impella pump (arrows). The patient's head is at 6 o'clock.
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After cardioplegic arrest and incision of the aorta, several perforations along the outer curvature were noted ( Fig. 3 ).