Transcatheter closure of an aortic root pseudoaneurysm following coronary artery bypass grafting.

A persistent aortic root pseudoaneurysm adjacent to the right coronary ostium was successfully treated using a transcatheter approach rather than repeat surgery.

• The patient was a man in his mid 70s with a history of coronary artery bypass grafting and prior surgical repair of an ascending aortic pseudoaneurysm using a bovine pericardial patch.
• The pseudoaneurysm persisted following prior surgical repair.
• A transcatheter approach was selected due to prior sternotomy and close proximity of the lesion to the coronary ostium.
• The case was described as anatomically challenging given the lesion's location near the right coronary ostium.

A dual-device transcatheter strategy successfully excluded the pseudoaneurysm while preserving coronary flow.

• A duct occluder device was deployed to exclude the pseudoaneurysm.
• A covered Papyrus coronary stent was subsequently deployed to reinforce the neck seal.
• The combined approach preserved coronary flow to the right coronary artery.
• The procedure was described as successful in excluding the pseudoaneurysm.

Multimodality imaging was identified as essential for diagnosis and procedural planning in this complex case.

• The case underscores 'the importance of multimodality imaging for diagnosis and procedural planning in complex, high-risk patients.'
• The anatomical proximity of the pseudoaneurysm to the right coronary ostium required detailed imaging to guide the transcatheter strategy.
• The case demonstrates 'the feasibility of a dual-device transcatheter strategy for managing persistent aortic pseudoaneurysms in anatomically challenging locations.'