PMC3825576_01
Apical pseudoaneurysm. A CT showing apical pseudoaneurysm. B Catheter positioned in the pseudoaneurysm at angiography. C Exclusion of the pseudoaneurysm by amplatzer septal occluder (arrow)
270_2012_540_Fig1_HTML.jpg
PMC3825576_01_270_2012_540_Fig1_HTML.jpg
Fig1
Consecutive CT examinations, performed 1 and again at 2 months after surgery, showed slowly increasing size of the pseudoaneurysm extending from the apex of the left ventricle (Fig. 1A) and a minor septum defect. After the tip of the catheter was positioned in the pseudoaneurysm, angiography was performed (Fig. 1B). After deployment of the distal part, the occluder and the guiding catheter were jointly pulled back until the operator could feel resistance, and then the other part of the occluder was deployed and the device released (Fig. 1C).
Second pseudoaneurysm at the bottom of the apex. A CT after 1 week demonstrates exclusion of the first pseudoaneurysm and the second aneurysm (arrow). B Angiography catheter tip positioned in the second pseudoaneurysm. C The second pseudoaneurysm excluded with the amplatzer
270_2012_540_Fig2_HTML.jpg
PMC3825576_01_270_2012_540_Fig2_HTML.jpg
Fig2
CT performed 10 days later verified absence of contrast flow to the treated pseudoaneurysm; however, the other pseudoaneurysm extending from the base of the apex was visualized (Fig. 2A). A new attempt at endovascular exclusion of the pseudoaneurysm was performed, using the same setting and technique, as described previously (Fig. 2B). Amplatz septal occluder in the second pseudoaneurysm, showed successful exclusion (Fig. 2C). Again, hemostasis was obtained by manual compression of the access site to the femoral artery after removal of all devices.
CT performed 3 months after the procedure. Three-dimensional reconstruction confirms exclusion of both pseudoaneurysms
270_2012_540_Fig3_HTML.jpg
PMC3825576_01_270_2012_540_Fig3_HTML.jpg
Fig3
At the next CT examinations 3 weeks and 3 months after the procedure, total exclusion of both pseudoaneurysms was seen (Fig. 3), and the patient was at this time in healthy condition.