PSEUDOANEURYSMS OF THE AORTA AFTER CARDIAC-SURGERY OR CHEST TRAUMA

Between March 1982 and June 1992, 17 patients (age: 21-76 years) were diagnosed with pseudoaneurysm of the thoracic aorta (PTA). Four PTAs d eveloped posttrauma while 13 developed after aortic or cardiac surgery . Unusual presentations included: dyspnea, hoarseness, dysphagia, mass ive hemoptysis (2 degrees to aortobronchial fistula), massive hemateme sis (2 degrees to aortoesophageal fistula), superior vena cava syndrom e, paralyzed right hemidiaphragm, and herald bleeding from the sternot omy. The interval between initial operation and recognition of PTA var ied from three months to eight years while the four posttraumatic PTAs presented 5 to 26 years postinjury. The sites of postoperative PTA we re: the aortotomy (3), proximal vein graft anastomosis (4), aortic can nulation site (2), and distal anastomosis of ascending aortic graft re placement (4). Aortography was very sensitive, outlining the false ane urysm in 13/13. Five patients had transesophageal echocardiography wit h one false negative. Seven patients died (41%), three from postoperat ive PTAs from massive hemorrhage intraoperatively and four from sepsis and multiorgan failure following repair. We conclude that patients wh o have previously had aortic or cardiac surgery or a history of blunt chest trauma presenting with unusual cardiorespiratory symptoms should be aggressively evaluated for PTA. Due to the magnitude of the operat ive problems encountered, repair of PTA is associated with a significa ntly high rate of mortality.