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J Thorac Cardiovasc Surg 2006;132:e17-e19
© 2006 The American Association for Thoracic Surgery

Brief Communication

Sixty-four–slice computed tomographic coronary angiography in pseudoaneurysm of the ascending aorta: A useful modality to supplement the diagnosis

Lars Husmann, MD a , Sebastian Leschka, MD a , Sacha P. Salzberg, MD b , Mario Lachat, MD b , Michele Genoni, MD b , Borut Marincek, MD a , Hatem Alkadhi, MD a , *

a Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland
b Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland

Received for publication April 27, 2006; accepted for publication May 9, 2006.

* Address for reprints: Hatem Alkadhi, MD, Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (Email: hatem.alkadhi@usz.ch).

The first 20% of the full text of this article appears below.

Invasive coronary angiography (ICA) is the reference standard for preoperative workup of coronary arteries in patients undergoing cardiac surgery. In dedicated cases, however, ICA may fail when altered anatomy prevents selective catheterization of the coronary ostia. We present the imaging findings of a 58-year-old man with an anastomotic pseudoaneurysm of a composite graft in whom coronary opacification with ICA failed and computed tomography (CT) supplemented the diagnosis.

Clinical Summary

A 58-year-old man was admitted to our hospital for the workup of recurrent cerebral transient ischemic attacks. Thirteen years earlier, the patient had undergone composite graft implantation for the treatment of aortic regurgitation caused by a congenital bicuspid aortic valve and an aneurysmal dilatation of the aortic root. Transesophageal echocardiography revealed a covered perforation of the composite graft at the distal anastomosis. Because the recurrent ischemic attacks were attributed to emboli of thrombotic material within the pseudoaneurysm, the patient was scheduled for surgical revision of the composite graft. For preoperative workup of the coronary arteries, the patient underwent an ICA. Because of the particular anatomy of the aortic root, however, neither the right nor the left coronary artery could . . . [Full Text of this Article]






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