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Case Reports
. 2025 Jun 4;30(13):103517.
doi: 10.1016/j.jaccas.2025.103517.

Management of a Sixth-Time Reoperation for Aortic Valve Disease With Aortic Pseudoaneurysm Invading the Sternum

Ryaan El-Andari  1 , Mansour Alomran  2 , Roderick G G MacArthur  3
Affiliations
Case Reports

Management of a Sixth-Time Reoperation for Aortic Valve Disease With Aortic Pseudoaneurysm Invading the Sternum

Ryaan El-Andari et al. JACC Case Rep. .

Abstract

Objectives: Reoperative cardiac surgery is technically demanding. We describe the case of a 57-year-old woman found to have an ascending aortic pseudoaneurysm invading the sternum at the time of her sixth cardiac reoperation.

Key steps: In cases of considerably challenging sternal re-entry, the following steps are imperative: 1) peripheral establishment of cardiopulmonary bypass; 2) systemic cooling; 3) circulatory arrest followed by sternotomy; and 4) rapid establishment of cerebral perfusion.

Potential pitfalls: The proximity and adherence of mediastinal structures to the posterior table of the sternum is of paramount significance when considering sternal re-entry. Completion of the sternotomy prior to systemic cooling and circulatory arrest carries an extremely high risk for exsanguination and mortality.

Take-home messages: This case describes the operative management of a patient undergoing a sixth sternotomy with an aortic pseudoaneurysm invading the sternum. Although challenging, this case could be performed successfully with careful attention to preoperative imaging, planning, and team communication.

Keywords: aortic valve; circulatory arrest; reoperation.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Preoperative Echocardiogram and Computed Tomography Scans Preoperative imaging with echocardiography demonstrating moderate aortic insufficiency (A). Computed tomography demonstrating an aortic pseudoaneurysm invading the sternum (B, C) and a stenotic segment of the descending thoracic aorta (D).
Figure 2
Figure 2
Intraoperative Images of the Sternotomy Intraoperative dissection of the inferior aspect of the sternum up to the level of the pseudoaneurysm (A) and dissection of the posterior table of the sternum following completion of the sternotomy (B).
Visual Summary
Visual Summary
Computed Tomography Scan Demonstrating an Aortic Pseudoaneurysm Invading the Sternum
See this image and copyright information in PMC

References

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