Structural Heart Disease > Cases

Transcatheter Coil Embolization for the Large Aortic Root Pseudoaneurysmin Patient with Takayasu Arteritis
- Operator: Seung-Jung Park, MD
Case Presentation
A 52 years-old female was admitted to our hospital for management of pseudoaneurysm at the suture site of Bentall surgery. 17 years ago, she underwent aortic valve replacement because of severe aortic regurgitation and 12 years ago, she also underwent Bentall surgery because of pannus formation at prosthetic mechanical valve. 3 months ago, she complained atypical chest discomfort and a pseudoaneurysm was detected on the CT incidentally. She had a medical history of Takayasu arteritis, Crohns disease and hypertension.
The size of peudoaneurysm by TEE and CT was 12-30mm (Figure 1). The 6mm-sized ostium of pseudoaneurysm was located in left inferior side of left main coronary artery ostium and there was no connection with LM. The coronary angiogram was normal (Figure 2, Figure 3).
Procedure
The aortic angiogram revealed large saccularpseudoaneurym near the left coronary artery ostium (Figure 4, Movie 1). With 6Fr Judkins JL5.0 guiding catheter, a 0.014 inch Transend wire was successfully introduced into the pseudoaneurysm under the support of Renegade microcatheter (Figure 5). Next, we advanced the Tornade embolization microcoils into the pseudoaneurysm until the space got obliterated (Figure 6, Figure 7). A total of 26 coils (Tornado Embolization Microcoil 10/4 mm x 4, 8/4 mm x 4, 6/2 mm x 4, 5/2 mm x 3, 4/2 mm x 4, 3/2 mm x 7) were deployed into the pseudoaneurysm. The final aortic angiogram confirmed complete obliteration of the pseudoaneurysm and there was no injury on left main coronary artery ( Movie 2).
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