Aortic pseudoaneurysm in a patient with systemic lupus erythematosus following Bentall procedure and coronary artery bypass grafting: a case report

Aortic pseudoaneurysm is among the most severe and life-threatening complications following cardiac surgery. Although technical failure or infection is commonly identified as the primary cause, underlying connective tissue disorders, such as systemic lupus erythematosus, may significantly increase susceptibility to pseudoaneurysm formation due to inherent tissue fragility. We report a case of a 49-year-old female patient with preoperative systemic lupus erythematosus who underwent a concomitant Bentall and coronary artery bypass grafting procedure. Four months postoperatively, she presented with hemorrhagic drainage from the upper sternal incision. Computed tomography angiography revealed a mediastinal mass and a large aortic pseudoaneurysm. Intraoperative assessment revealed dehiscence at the anastomotic sites of both the left main coronary artery button and the saphenous vein graft to the right coronary artery, where they were attached to the Bentall graft.The pseudoaneurysm was completely excised, and the left main coronary artery was reconstructed using a prosthetic graft. The patient was discharged after reoperation. This case emphasizes the importance of considering systemic autoimmune diseases, particularly systemic lupus erythematosus, as a contributing factor to vascular complications following aortic root replacement. Systemic lupus erythematosus-related connective tissue fragility may impair graft healing and anastomotic integrity, even in the absence of infection. Prompt diagnosis and timely surgical intervention are essential to mitigate the risk of mortality and improve clinical outcomes.