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).