Figure 2. A) Sagittal section demonstrating the enlarging aortic pseudoaneurysm. Of note is the relationship of the pseudoaneurysm neck in relation to the right main pulmonary artery on this image. This relationship was used as an anatomical landmark; constant between CT and TEE imaging for planning the position of the endoballoon intraoperatively relative to the patent coronary grafts more proximally which was critical to successful endoballoon placement B) Axial CT images showing the proximity of the pseudoaneurysm to the posterior sternal table highlighting the risk of rupture upon re-entry.
Surgery was carried out using right axillary cannulation with a Y to the right common femoral artery. A venous access cannula was placed in the right femoral vein. An endoballoon was advanced from the left femoral artery to the distal ascending aorta just distal to the aortocoronary grafts using a combination of fluoroscopy and TEE (Figure 3).