COMPRESSION OF A COMPOSITE GRAFT BY A PERI-AORTIC PSEUDOANEURYSM IN APOSTOPERATIVE MARFAN PATIENT

A previously well 35-year-old female was referred to hospital with a f our-week history of intermittent chest pain. She had a history of Marf an syndrome when she presented II years previously with aortic insuffi ciency and underwent replacement of the aortic root with a composite g raft. Magnetic resonance examination of the chest and coronary angiogr aphy revealed an area of extraluminal flow posteromedially at the base of the aortic graft with no evidence of dissection. Transesophageal e chocardiography clearly demonstrated the presence of a pseudoaneurysm that resulted from detachment of the left coronary artery from the gra ft, with intermittent compression of the aortic graft during systole. The patient underwent uneventful resection and replacement of the fals e aneurysm and patch repair of the left coronary artery. This unusual case illustrates the presence of a pseudoaneurysm as a result of detac hment of the left coronary artery from a Dacron graft 11 years after a composite graft replacement.