Figure 3 A) TEE image demonstrating preoperative aortic pseudoaneurysm along the anterior aspect of the ascending aorta, the right main pulmonary artery was utilized as a landmark for endoballoon positioning safely above the patent proximal coronary anastomoses B) Intraoperative image demonstrating the inflated endoballoon in situ above the patent grafts while cardioplegia was being delivered to the aortic root.
A percutaneous retrograde cardioplegia catheter was advanced under TEE guidance into the coronary sinus. Cardiopulmonary bypass was commenced and upon re-sternotomy bleeding was encountered from the pseudoaneurysm. The endoballoon was inflated above the proximal coronary anastomoses to occlude the aorta and control the bleeding. The endoballoon also served to deliver antegrade cardioplegia. In view of the patent LIMA-LAD graft, continuous retrograde cardioplegia and systemic hyperkalemia also instituted and cardioplegic arrest was achieved; during this period the endoballoon served as a vent. Further dissection was carried out revealing a 1cm defect in the distal ascending aorta at the previous cannulation site (Figure 4).