CTICasesInfected Aortic Root Pseudoaneurysm Compressing the Left Main Coronary Artery
Imaging findings
In an intravenous drug user with a recent prosthetic aortic valve, imaging a few months after surgery showed a fluid collection around the aortic root with a small outpouching at the anastomosis and annulus consistent with a pseudoaneurysm. When the patient returned two months later after being lost to follow-up with inadequate treatment, the pseudoaneurysm had progressed dramatically into a massive aortic root pseudoaneurysm involving both leaflets, compressing and stretching the left main coronary artery with associated hypoperfusion of the left main territory.
Key takeaways
This case illustrates the rapid, dramatic progression of an infected prosthetic valve pseudoaneurysm when treatment is incomplete or interrupted, including the rare complication of extrinsic left main coronary artery compression. The patient underwent successful surgical replacement of the aortic root and ascending aorta with a composite valve graft and recovered without lasting cardiac sequelae.
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