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).