A 65-year-old man was hit by a piece of wood on the middle of the chest while doing woodwork 20 years ago, and he was comatose. After 3 days of intensive care and treatment, he was discharged. He lived a normal life until he began to feel chest pain after exercise 2 years ago. Chest X-ray revealed a slightly enlarged heart (Fig. 1a). Computed tomography showed that the root of the ascending aorta had ruptured into a low-density mass (9.8×9.0 cm) and clarified that the mass was a chronic aortic pseudoaneurysm (Fig. 1b and 1c, arrow). The right atrium and right ventricle were visibly deformed because of the pseudoaneurysm (Fig. 1d and 1e, arrow). Coronary angiography revealed a normal left coronary artery and an occluded right coronary artery (Fig. 1f). The patient received surgical intervention under cardiopulmonary bypass. Intraoperative transesophageal echocardiography showed that the pseudoaneurysm was located in the right coronary sinus and its diameter was 26.5 mm (Fig. 1g, Fig. 1 arrow). We found that the pseudoaneurysm was fused together with the heart (Fig. 1h, Fig. 1 arrow). The border of the pseudoaneurysm was difficult to distinguish, and it felt hard, with some calcified plaques on its surface (Fig. 1h, Fig. 1 arrow); thus, neither pseudoaneurysm resection nor right coronary artery bypass grafting was possible. Therefore, we closed the right coronary sinus with a bovine pericardial patch through an aortic incision. Postoperative color Doppler ultrasonography did not reveal any blood flow from the aorta into the pseudoaneurysm (Fig. 1i, Fig. 1 arrow). The patient recovered well and was discharged 7 days after admission.
Figure 1.
(a) Chest X-ray showed a slightly enlarged hear. (b-c) CT showed that the mass located in the root of the ascending aorta was a chronic aortic pseudoaneurysm. (d-e) The right atrium and right ventricle were visibly deformed. (f) Coronary angiography revealed an occluded right coronary artery. (g) Intraoperative transesophageal echo-cardiography showed that the pseudoaneurysm was located in the right coronary sinus. (h) Pseudoaneurysm was fused together with the heart. (i) Postoperative color Doppler didn’t show any blood flow from the aorta into the pseudoaneurysm