Ascending aorta pseudoaneurysm 40 years following surgical atrial septal defect repair – A case report and literature review

IntroductionAscending aortic pseudoaneurysm is a rare postoperative complication of cardiac surgery, often linked to infection and dehiscence at sites of aortotomy, cannulation, cross-clamp sites, and proximal coronary anastomoses.Case ReportWe present a case of an ascending aortic pseudoaneurysm in 48-year-old woman who underwent atrial septal defect repair at 8 years old. Based on pre-operative imaging and intra-operative findings, the pseudoaneurysm developed from previous cardioplegia cannula site. She underwent emergency surgery where the pseudoaneurysm was resected and repaired with a Gelweave patch. The patient recovered well with no post-operative chest pain or dyspnoea at 5-months follow-up.ConclusionCardioplegia cannula remains a rare but significant iatrogenic cause of aortic pseudoaneurysm. Prevention of pseudoaneurysm formation can be achieved by inserting the cardioplegia cannula tip through full-thickness purse-strings and/or addition of separate oversewing sutures after decannulation during the primary operation.