PSEUDOANEURYSM FOLLOWING AORTIC HOMOGRAFT - CLINICAL IMPLICATIONS

Objective-To determine the prevalence of pseudoaneurysm formation afte r aortic (left ventricular outflow tract) homograft implantation and t o evaluate predisposing factors. Methods-Echocardiographic data were a nalysed in 30 patients for evidence of pseudoaneurysm formation after homograft implantation. Pseudoaneurysm was characterised as a perfused echo-free space between the homograft and the native aortic wall comm unicating with the left ventricular outflow tract. Clinical data were analysed for potential predisposing factors for pseudoaneurysm formati on.Results-Pseudoaneurysms were found in 22 of 30 patients. Mean age, length of follow up after surgery, aortic systolic pressure gradient ( 15 (SD 12) v 10 (4) mm Hg), aortic root diameter, and size of the homo grafts were comparable in patients with and without pseudoaneurysm. Pr eoperative infection, operating techniques, and whether first or reope ration did not affect pseudoaneurysm formation. However, pseudoaneurys ms were often localised at the site of an abscess or a paravalvular le ak after eradicated prosthetic valve endocarditis. Conclusions-(1) Dop pler echocardiography demonstrates that pseudoaneurysm formation is co mmon after aortic homograft implantation. (2) A prospective study is n eeded to clarify the prognostic importance of pseudoaneurysms. (3) The high incidence of pseudoaneurysm formation may lead to an improvement of surgical technique (application of fibrin glue).