520 AN UNEXPECTED SURPRISE


 Aortic Pseudoaneurysms often represent a complication of reconstructive surgery of the aortic valve and ascending aorta due to dehiscence of the surgical suture, especially in correspondence of reimplanted coronary ostia. We present the case of a 74-year-old patient with a recent feverish episode and positive blood cultures for Serratia marcescens, who came to our attention to perform a transesophageal echocardiogram for suspected endocarditis.
 In history, previous aortic valve replacement with biological prosthesis about 6 months before, complicated by pseudoaneurysm of the ascending aorta caused by dehiscence of sutures, treated by pseudoaneurismectomy and reconstruction of aortic continuity.
 Transesophageal echo showed a normopositioned bioprosthesis in the aortic location and absence of formations compatible with vegetations. During the examination, a subtle drop-out of echoes in the anterior wall of the ascending aorta was observed at approximately 2 cm from the aortic valve plane, raising suspicion of communication with a large pseudoaneurysmal sac. The Colordoppler showed a jet of discrete turbulence between the two cavities; for these reasons it was indicated to perform an urgent angioTC, which documented the presence of fissuring of the proximal ascending aorta with active overflow of contrast media with a collar of about 12 mm and considerable blood collection in the anterior mediastinum of about 51×38×60mm.
 The patient underwent false lumen exclusion surgery by percutaneous amplatzer device placement. Currently, the patient is asymptomatic and in good clinical condition.