Transcatheter intervention for complex ascending aortic pseudoaneurysm after cardiac surgery.

TEE Perioperative 2D-TEE and RT 3D-TEE were carried out with a 5.5-MHz new matrix array X7-2t transducer and a commercially available Philips iE33 ultrasound system after induction of anesthesia and endotracheal intubation.9–12 RT 3D-TEE was performed at the end of a comprehensive 2D-TEE examination and used for the assessment of PsA lesions, guidance of the catheter intervention, device selection and positioning, postrepair examination of residual leak and identification of any additional aortic abnormality (ie, dissection, pericardial effuscending pseudoaneurysm (PsA) is a rare complication of aortic root and/or cardiac valve surgery and generally, surgical intervention is advised to avoid high cardiac output failure.1–5 Redo surgery, however, is often associated with high morbidity and mortality in such cases. Surgical management is always mandatory because of lethal complication. In recent years, endovascular treatment of aortic pathology with endoluminal graft has emerged as a minimally invasive alternative to open surgery repair.6,7 Despite these advances, endovascular graft therapy in aortic root or ascending PsA remains technically challenging due to short landing zones, which may cause coronary compromise. Two-dimensional transesophageal echocardiography (2DTEE) with color flow and pulsed Doppler imaging has been shown to be useful in the diagnosis of suspected PsA.8 The neck of the PsA, however, has a complex geometry between the lesion and the surrounding native tissue. The dimension, location and length of the neck of the PsA viewed on conventional 2D-TEE alone might be inadequate, but 3D-TEE provides precise imaging of shape, size and length of the lesion A