Repair of a pseudoaneurysm of the ascending aorta after aortic valve replacement

An elderly woman underwent an aortic valve replacement and 5 months later d eveloped a pseudoaneurysm from the anterior aspect of the proximal ascendin g aorta (AA). The pseudoaneurysm was approached through a redo-median stern otomy, on cardiopulmonary bypass (CPB), mild hypothermia, and a beating hea rt, with a temporary fingertip occlusion of its ostium, and repaired succes sfully using mattress monofilament sutures enforced by pledgets. The standa rd approach to such pseudoaneurysms is a CPB and hypothermic circulatory ar rest (HCA) prior to mid-sternotomy, and replacement of the AA. But, when a pseudoaneurysm arises from a narrow ostium on the anterior aspect of the AA , as in this case, it can be sutured closed with pledgets under CPB with a mild hypothermia and a beating heart.