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Use of an Amplatzer ASD Occlusion Device for the Closure of an Ascending Aortic Pseudoaneurysm Presenting as Hemoptysis

Use of an Amplatzer ASD Occlusion Device for the Closure of an Ascending Aortic Pseudoaneurysm... Hindawi Journal of Interventional Cardiology Volume 2022, Article ID 9809289, 4 pages https://doi.org/10.1155/2022/9809289 Research Article Use of an Amplatzer ASD Occlusion Device for the Closure of an Ascending Aortic Pseudoaneurysm Presenting as Hemoptysis 1 1 2 Nicholas P. Kondoleon , Christopher Kanaan, Jonathan Hansen , and Samir R. Kapadia Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland 44195, OH, USA Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland 44195, OH, USA Correspondence should be addressed to Samir R. Kapadia; kapadis@ccf.org Received 4 January 2022; Revised 17 January 2022; Accepted 20 January 2022; Published 11 February 2022 Academic Editor: Viktor Kocˇka Copyright © 2022 Nicholas P. Kondoleon et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aortic pseudoaneurysms can commonly be caused by previous thoracic surgery, trauma, and infection, quickly becoming life- threatening if ruptured. +is pathology is typically asymptomatic and incidentally found on imaging; however, few cases have outlined hemoptysis as a presenting symptom for aortic pseudoaneurysms. Traditionally, management of these patients included surgical correction; however, percutaneous approaches have emerged as a safe alternative, helping to reduce the risk of morbidity and mortality associated with surgical correction. +is report seeks to describe a case in which hemoptysis was the symptom unveiling the finding of a thoracic ascending aortic pseudoaneurysm and the use of an Amplatzer atrial septal defect (ASD) occlusion device as a viable option to safely resolve the disease process. rare presenting symptom, but may be present as a result of 1. Introduction erosion of the surrounding airway and lung parenchyma and A pseudoaneurysm is defined as an expectoration of blood disruption to the surrounding bronchial arteries. from the true lumen of a vessel, containing the connective +e atrial septal defect (ASD) occluder device was first tissue of the blood vessel and the adventitia. In contrast, a introduced in 1975 by King and Mills as an alternative to true aneurysm is defined as a progressive, nonreversible traditional surgical corrections of ASDs, decreasing mor- process in which all three layers of the blood vessel form an tality and morbidity. Since that time, the device has evolved outpouching. Common causes of aortic aneurysms include to become the mainstay of treatment for the correction of atherosclerosis, infections, connective tissue disorders, au- ASDs. Today, the Amplatzer ASD occlusion device is the toimmune disorders, and chest trauma, among others [1]. most commonly used device. +e device is deployed per- One case report, also, describes radiation therapy as a cutaneously and consists of a self-expanding double disk composed of nitinol mesh, sitting on both sides of the septal precipitant for aortic wall weakening and rupture [2]. Pseudoaneurysms, however, are more commonly caused by defect and occluding the defect. In recent years, the ASD previous thoracic surgery, trauma, and infection [1]. +o- occlusion device has been utilized as a solution to many racic pseudoaneurysms tend to have few symptoms and are other pathologies—in addition to ASD closure—including incidentally found on chest imaging and, however, can aortic pseudoaneurysms, false dissection lumens, aortocaval become life-threatening quickly if ruptured. Hemoptysis is a fistulas, and sinus of valsalva aneurysms, among others. 2 Journal of Interventional Cardiology the descending aorta using a left coronary bypass (LCB) 2. Case Report catheter. +is demonstrated no appreciable communication A 64-year-old male presented to the hospital for hemoptysis. between the pseudoaneurysm and bronchial artery. An 8 Fr He had a history of coronary artery disease and had a shuttle sheath was advanced within a 10 Fr R sheath over a coronary artery bypass graft (CABG) in 2004 (left internal Wholey wire. A 16 mm ASD Amplatzer occlusion device was mammary artery (LIMA)-left anterior descending (LAD), then advanced over the 8 Fr shuttle and deployed to the saphenous vein graft (SVG)-obtuse marginal (OM1), SVG- pseudoaneurysm without complication. Angiography fol- diagonal (Dg), and SVG-posterior descending artery (PDA)) lowing deployment showed no residual flow into the and repeat in 2018 (LIMA-LAD and SVG-Dg patent, SVG- pseudoaneurysm, confirming occlusion. right coronary artery (RCA), SVG-left circumflex (LCx), and +e patient was discharged four days following admis- SVG-LAD). He also had a history of Hodgkin’s lymphoma sion. He followed up in the cardiology clinic one month after treated with chemotherapy and radiation that was com- discharge with resolution of his hemoptysis and no post- pleted in 2019, type II diabetes complicated by retinopathy, intervention complications. At the time of his follow-up hypertension, and hyperlipidemia. +e patient began ex- appointment, he had a repeat CTA showing a well-sealed periencing hemoptysis in November 2020. +is episode was plug in the anterior mid-ascending aorta with occlusion of followed by three more episodes: ten days from the first the prior pseudoaneurysm and no overt contrast flow (lasting three days), ten days following the second episode around the device (Figure 3). +e patient then returned to (isolated, one time), and once in December 2020 (isolated, his home country with continued follow-up with his home one time). For the past three years, he had suffered from a physicians. nonproductive cough, but only as of November, had it become productive of blood on these accounts. Following 3. Discussion the first episode of hemoptysis, he was admitted for eval- uation and reported staying for only one day following Few cases in the current literature describe hemoptysis as a resolution of symptoms in a hospital abroad. He reported presenting symptom for the finding of a thoracic aortic returning to the hospital in December, where he had a 5-day pseudoaneurysm [3–5]. In patients with recurrent hemop- hospitalization with computed tomography angiography tysis of unknown origin, it is currently recommended to (CTA) showing a dilated thoracic aorta and treatment with obtain a CT scan of the chest and, if unrevealing, obtain a “cough medicine and antibiotics.” Pictures of the hemop- bronchoscopy for direct visualization of the airways. In this tysis from the patient showed blood-soaked tissues<500 mL. patient, clinical presentation indicated a three-month his- Other symptoms the patient endorses are chest pain radi- tory of recurrent, non-life-threatening hemoptysis. CT scan ating to back with episodes of hemoptysis, shortness of of the chest was revealing a pseudoaneurysm in the as- breath, and sore throat. +e patient remained hemody- cending aorta and a questionable area of bronchiectasis in namically stable through his stay with stable hemoglobin. the right upper lobe. Bronchoscopy was discussed, but During this admission, his echocardiogram showed an deferred following the decision to proceed with a percuta- ejection fraction of 51%, grade I diastolic dysfunction, a neous closure of his pseudoaneurysm. +e most common resting wall abnormality in the RCA territory, and only trace causes of recurrent hemoptysis include bronchiectasis, aortic regurgitation. +e patient brought CTA images from carcinoid tumors, AV malformations, and pseudohemopt- his prior admission in December. Review of the CTA ysis. Bronchial pseudoaneurysms are also a known cause of revealed a linear area in the right upper lobe (RUL) rep- hemoptysis; however, thoracic aortic pseudoaneurysms resentative of bronchiectasis consistent with his prior ra- presenting with hemoptysis are rare. +oracic pseudoa- diation therapy, a subtle enhancement in the RUL, and an neurysms can often remain clinically silent; however, the- aneurysmal outpouching of the thoracic ascending aorta orized mechanisms of hemoptysis include erosion of with no appreciable communication to the RUL (Figure 1). surrounding parenchyma as a result of compression from Pulmonology was consulted for hemoptysis, and bron- the pseudoaneurysm [5], alteration of the surrounding lung choscopy with bronchoalveolar lavage was considered, but architecture, resulting in bronchial artery hyperplasia and deferred following the below findings. Infectious workup tortuosity and increased susceptibility to rupture [6], for- and autoimmune workups were deferred due to no systemic mation of an aortobronchial fistula, and rupture of the signs of each. pseudoaneurysm. +ese complications can quickly become +e patient remained hemodynamically stable with no life-threatening, specifically in the case of ruptured pseu- need for red blood cell transfusions through his admission. doaneurysms. In the case of an aortobronchial fistula, He was taken for a diagnostic angiography and percutaneous though rare, left-to-right shunting can manifest as heart closure of the pseudoaneurysm on day three of his admis- decompensation or cardiogenic shock, lending to challenges sion. +e diagnostic angiography demonstrated known se- in care due to hemodynamic instability [7]. vere native artery disease including a chronic total occlusion Traditionally, surgery was the recommended approach of the LAD, proximal LCx, and proximal RCA, with patent for the correction of thoracic pseudoaneurysms; however, it grafts. Following this, the ascending aortic pseudoaneurysm carries a risk of 7%–41% mortality [8]. As a result, percu- was engaged identifying a pseudoaneurysm similar to the taneous, endovascular approaches have emerged as a viable CTA findings (Figure 2). An arch aortogram was used to alternative to traditional therapy. In the past decade, case identify the bronchial artery, which was then engaged from reports have described the successful treatment of aortic Journal of Interventional Cardiology 3 (a) (b) Figure 1: Computed tomography angiography demonstrating a large aortic pseudoaneurysm within the anterior ascending aorta. Figure 2: Invasive angiography with engagement of the ascending aortic arch, demonstrating a pseudoaneurysm in the anterior mid- ascending aorta. (a) LAO caudal view. (b) RAO cranial view. Figure 3: Computed tomography angiography demonstrating no overt contrast flow around a well-sealed ASD Amplatzer occlusion device within the ascending aortic anterior pseudoaneurysm one month following the procedure. 4 Journal of Interventional Cardiology [4] H. Zhang, M. Zheng, J. Bu, H. Zhang, M. Zheng, and J. Bu, “A pseudoaneurysms using ASD occlusion devices, percuta- case of thoracic aortic aneurysm with hemoptysis as the first neously [8–12]. Additionally, Touˇsek et al. described a case in symptom,” Journal of Biosciences and Medicines, vol. 08, which an endovascular closure of a pseudoaneurysm no. 10, pp. 33–37, 2020. complicated by an aortobronchial fistula helped to alleviate [5] A. Podugu, M. Adam, and N. Boutros, “Hemoptysis: an the hemodynamic challenges that would have been faced unusual presentation for the pseudoaneurysm of aortic arch,” during a surgical correction alone due to left-to-right Chest, vol. 144, no. 4, p. 143A, 2013. shunting [7]. Use of endovascular techniques for pseu- [6] L. A. Rodr´ıguez-Hidalgo, L. A. Concepcion-Urteaga, ´ doaneurysm closure has been shown to be feasible and safe, J. S. Hilario-Vargas, and D. C. Ruiz-Caballero, “Hemoptysis as helping to avoid complications that arise with high-risk a warning sign of thoracic aorta pseudoaneurysm: a case surgical repair. In this case, the patient’s history of a CABG report,” Medwave, vol. 21, no. 1, Article ID e8112, 2021. and radiation therapy predisposed him to the formation of a [7] P. Touˇsek, V. P. R. Koca, ˇ J. Ulman, J. Hlavicka, ˇ and M. Kolesar, “Use of Amplatzer occludes for treatment of thoracic pseudoaneurysm. Use of a 16 mm ASD Amplatzer aorto-pulmonary fistulas-case and review of the literature,” occlusion device deployed percutaneously proved to be a Expert Review of Medical Devices, vol. 14, no. 11, pp. 845–847, viable and safe option for the patient, resulting in successful occlusion with no residual contrast flow around the device [8] L. Carmans, P. De Meester, W. Budts, and E. Troost, “Per- on CTA one month following the procedure. cutaneous closure of an uncommon aortic pseudoaneurysm after arterial switch repair: a case report,” European Heart 4. Conclusion Journal-Case Reports, vol. 3, no. 4, pp. 1–4, 2019. [9] J. Stehli, F. S. Alie-Cusson, J. M. Panneton, and Although rare, hemoptysis has been described in few case P. D. Mahoney, “Percutaneous closure of iatrogenic ascending reports as the presenting symptom of thoracic pseudoa- aortic pseudoaneurysms following surgical aortic repair,” neurysms due to erosion of the surrounding airway and lung Journal of the American College of Cardiology: Case Reports, parenchyma, increased fragility and susceptibility to rupture vol. 3, no. 2, pp. 327–333, 2021. of surrounding bronchial arteries, formation of aorto- [10] J. Hussain, R. Strumpf, G. Wheatley, and E. Diethrich, “Percutaneous closure of aortic pseudoaneurysm by bronchial fistulas, or rupture. In this case, treatment with a Amplatzer occluder device-case series of six patients,” 16 mm ASD Amplatzer occlusion device resulted in reso- Catheterization and Cardiovascular Interventions, vol. 73, lution of the patient’s recurrent hemoptysis and avoidance of no. 4, pp. 521–529, 2009. high-risk surgical repair and its complications. [11] F. Bashir, R. Quaife, and J. D. Carroll, “Percutaneous closure of ascending aortic pseudoaneurysm using Amplatzer septal Data Availability occluder device: the first clinical case report and literature review,” Catheterization and Cardiovascular Interventions, No data were used to support this study. vol. 65, no. 4, pp. 547–551, 2005. [12] S. Delorme, P. Ruchat, and J. J. Goy, “Percutaneous treatment Conflicts of Interest of late complications of the Bentall procedure,” Catheteri- zation and Cardiovascular Interventions, vol. 92, no. 2, +e authors declare that they have no conflicts of interest. pp. 348–352, 2018. Authors’ Contributions All authors participated in drafting and revising the man- uscript critically for important intellectual content. Acknowledgments +is report was supported by the Department of Cardio- vascular Disease at Cleveland Clinic. References [1] L. F. Hiratzka, G. L. Bakris, J. A. Beckman et al., “ACCF/AHA/ AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease,” Circulation, vol. 121, no. 13, pp. 266–369, 2010. [2] Y. Kawatani, H. Kurobe, Y. Nakamura, Y. Suda, and T. Hori, “Aortic rupture due to radiation injury successfully treated with thoracic endovascular aortic repair,” Journal of Surgical Case Reports, vol. 2017, no. 5, pp. rjx092–4, 2017. [3] Y. Q. Lu, F. Yao, A. D. Shang, and J. Pan, “Pseudoaneurysm of the aortic arch: a rare case report of pulmonary cancer complication,” Medicine (Baltimore), vol. 95, no. 31, p. e4457, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Interventional Cardiology Hindawi Publishing Corporation

Use of an Amplatzer ASD Occlusion Device for the Closure of an Ascending Aortic Pseudoaneurysm Presenting as Hemoptysis

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Copyright © 2022 Nicholas P. Kondoleon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hindawi Journal of Interventional Cardiology Volume 2022, Article ID 9809289, 4 pages https://doi.org/10.1155/2022/9809289 Research Article Use of an Amplatzer ASD Occlusion Device for the Closure of an Ascending Aortic Pseudoaneurysm Presenting as Hemoptysis 1 1 2 Nicholas P. Kondoleon , Christopher Kanaan, Jonathan Hansen , and Samir R. Kapadia Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland 44195, OH, USA Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland 44195, OH, USA Correspondence should be addressed to Samir R. Kapadia; kapadis@ccf.org Received 4 January 2022; Revised 17 January 2022; Accepted 20 January 2022; Published 11 February 2022 Academic Editor: Viktor Kocˇka Copyright © 2022 Nicholas P. Kondoleon et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aortic pseudoaneurysms can commonly be caused by previous thoracic surgery, trauma, and infection, quickly becoming life- threatening if ruptured. +is pathology is typically asymptomatic and incidentally found on imaging; however, few cases have outlined hemoptysis as a presenting symptom for aortic pseudoaneurysms. Traditionally, management of these patients included surgical correction; however, percutaneous approaches have emerged as a safe alternative, helping to reduce the risk of morbidity and mortality associated with surgical correction. +is report seeks to describe a case in which hemoptysis was the symptom unveiling the finding of a thoracic ascending aortic pseudoaneurysm and the use of an Amplatzer atrial septal defect (ASD) occlusion device as a viable option to safely resolve the disease process. rare presenting symptom, but may be present as a result of 1. Introduction erosion of the surrounding airway and lung parenchyma and A pseudoaneurysm is defined as an expectoration of blood disruption to the surrounding bronchial arteries. from the true lumen of a vessel, containing the connective +e atrial septal defect (ASD) occluder device was first tissue of the blood vessel and the adventitia. In contrast, a introduced in 1975 by King and Mills as an alternative to true aneurysm is defined as a progressive, nonreversible traditional surgical corrections of ASDs, decreasing mor- process in which all three layers of the blood vessel form an tality and morbidity. Since that time, the device has evolved outpouching. Common causes of aortic aneurysms include to become the mainstay of treatment for the correction of atherosclerosis, infections, connective tissue disorders, au- ASDs. Today, the Amplatzer ASD occlusion device is the toimmune disorders, and chest trauma, among others [1]. most commonly used device. +e device is deployed per- One case report, also, describes radiation therapy as a cutaneously and consists of a self-expanding double disk composed of nitinol mesh, sitting on both sides of the septal precipitant for aortic wall weakening and rupture [2]. Pseudoaneurysms, however, are more commonly caused by defect and occluding the defect. In recent years, the ASD previous thoracic surgery, trauma, and infection [1]. +o- occlusion device has been utilized as a solution to many racic pseudoaneurysms tend to have few symptoms and are other pathologies—in addition to ASD closure—including incidentally found on chest imaging and, however, can aortic pseudoaneurysms, false dissection lumens, aortocaval become life-threatening quickly if ruptured. Hemoptysis is a fistulas, and sinus of valsalva aneurysms, among others. 2 Journal of Interventional Cardiology the descending aorta using a left coronary bypass (LCB) 2. Case Report catheter. +is demonstrated no appreciable communication A 64-year-old male presented to the hospital for hemoptysis. between the pseudoaneurysm and bronchial artery. An 8 Fr He had a history of coronary artery disease and had a shuttle sheath was advanced within a 10 Fr R sheath over a coronary artery bypass graft (CABG) in 2004 (left internal Wholey wire. A 16 mm ASD Amplatzer occlusion device was mammary artery (LIMA)-left anterior descending (LAD), then advanced over the 8 Fr shuttle and deployed to the saphenous vein graft (SVG)-obtuse marginal (OM1), SVG- pseudoaneurysm without complication. Angiography fol- diagonal (Dg), and SVG-posterior descending artery (PDA)) lowing deployment showed no residual flow into the and repeat in 2018 (LIMA-LAD and SVG-Dg patent, SVG- pseudoaneurysm, confirming occlusion. right coronary artery (RCA), SVG-left circumflex (LCx), and +e patient was discharged four days following admis- SVG-LAD). He also had a history of Hodgkin’s lymphoma sion. He followed up in the cardiology clinic one month after treated with chemotherapy and radiation that was com- discharge with resolution of his hemoptysis and no post- pleted in 2019, type II diabetes complicated by retinopathy, intervention complications. At the time of his follow-up hypertension, and hyperlipidemia. +e patient began ex- appointment, he had a repeat CTA showing a well-sealed periencing hemoptysis in November 2020. +is episode was plug in the anterior mid-ascending aorta with occlusion of followed by three more episodes: ten days from the first the prior pseudoaneurysm and no overt contrast flow (lasting three days), ten days following the second episode around the device (Figure 3). +e patient then returned to (isolated, one time), and once in December 2020 (isolated, his home country with continued follow-up with his home one time). For the past three years, he had suffered from a physicians. nonproductive cough, but only as of November, had it become productive of blood on these accounts. Following 3. Discussion the first episode of hemoptysis, he was admitted for eval- uation and reported staying for only one day following Few cases in the current literature describe hemoptysis as a resolution of symptoms in a hospital abroad. He reported presenting symptom for the finding of a thoracic aortic returning to the hospital in December, where he had a 5-day pseudoaneurysm [3–5]. In patients with recurrent hemop- hospitalization with computed tomography angiography tysis of unknown origin, it is currently recommended to (CTA) showing a dilated thoracic aorta and treatment with obtain a CT scan of the chest and, if unrevealing, obtain a “cough medicine and antibiotics.” Pictures of the hemop- bronchoscopy for direct visualization of the airways. In this tysis from the patient showed blood-soaked tissues<500 mL. patient, clinical presentation indicated a three-month his- Other symptoms the patient endorses are chest pain radi- tory of recurrent, non-life-threatening hemoptysis. CT scan ating to back with episodes of hemoptysis, shortness of of the chest was revealing a pseudoaneurysm in the as- breath, and sore throat. +e patient remained hemody- cending aorta and a questionable area of bronchiectasis in namically stable through his stay with stable hemoglobin. the right upper lobe. Bronchoscopy was discussed, but During this admission, his echocardiogram showed an deferred following the decision to proceed with a percuta- ejection fraction of 51%, grade I diastolic dysfunction, a neous closure of his pseudoaneurysm. +e most common resting wall abnormality in the RCA territory, and only trace causes of recurrent hemoptysis include bronchiectasis, aortic regurgitation. +e patient brought CTA images from carcinoid tumors, AV malformations, and pseudohemopt- his prior admission in December. Review of the CTA ysis. Bronchial pseudoaneurysms are also a known cause of revealed a linear area in the right upper lobe (RUL) rep- hemoptysis; however, thoracic aortic pseudoaneurysms resentative of bronchiectasis consistent with his prior ra- presenting with hemoptysis are rare. +oracic pseudoa- diation therapy, a subtle enhancement in the RUL, and an neurysms can often remain clinically silent; however, the- aneurysmal outpouching of the thoracic ascending aorta orized mechanisms of hemoptysis include erosion of with no appreciable communication to the RUL (Figure 1). surrounding parenchyma as a result of compression from Pulmonology was consulted for hemoptysis, and bron- the pseudoaneurysm [5], alteration of the surrounding lung choscopy with bronchoalveolar lavage was considered, but architecture, resulting in bronchial artery hyperplasia and deferred following the below findings. Infectious workup tortuosity and increased susceptibility to rupture [6], for- and autoimmune workups were deferred due to no systemic mation of an aortobronchial fistula, and rupture of the signs of each. pseudoaneurysm. +ese complications can quickly become +e patient remained hemodynamically stable with no life-threatening, specifically in the case of ruptured pseu- need for red blood cell transfusions through his admission. doaneurysms. In the case of an aortobronchial fistula, He was taken for a diagnostic angiography and percutaneous though rare, left-to-right shunting can manifest as heart closure of the pseudoaneurysm on day three of his admis- decompensation or cardiogenic shock, lending to challenges sion. +e diagnostic angiography demonstrated known se- in care due to hemodynamic instability [7]. vere native artery disease including a chronic total occlusion Traditionally, surgery was the recommended approach of the LAD, proximal LCx, and proximal RCA, with patent for the correction of thoracic pseudoaneurysms; however, it grafts. Following this, the ascending aortic pseudoaneurysm carries a risk of 7%–41% mortality [8]. As a result, percu- was engaged identifying a pseudoaneurysm similar to the taneous, endovascular approaches have emerged as a viable CTA findings (Figure 2). An arch aortogram was used to alternative to traditional therapy. In the past decade, case identify the bronchial artery, which was then engaged from reports have described the successful treatment of aortic Journal of Interventional Cardiology 3 (a) (b) Figure 1: Computed tomography angiography demonstrating a large aortic pseudoaneurysm within the anterior ascending aorta. Figure 2: Invasive angiography with engagement of the ascending aortic arch, demonstrating a pseudoaneurysm in the anterior mid- ascending aorta. (a) LAO caudal view. (b) RAO cranial view. Figure 3: Computed tomography angiography demonstrating no overt contrast flow around a well-sealed ASD Amplatzer occlusion device within the ascending aortic anterior pseudoaneurysm one month following the procedure. 4 Journal of Interventional Cardiology [4] H. Zhang, M. Zheng, J. Bu, H. Zhang, M. Zheng, and J. Bu, “A pseudoaneurysms using ASD occlusion devices, percuta- case of thoracic aortic aneurysm with hemoptysis as the first neously [8–12]. Additionally, Touˇsek et al. described a case in symptom,” Journal of Biosciences and Medicines, vol. 08, which an endovascular closure of a pseudoaneurysm no. 10, pp. 33–37, 2020. complicated by an aortobronchial fistula helped to alleviate [5] A. Podugu, M. Adam, and N. Boutros, “Hemoptysis: an the hemodynamic challenges that would have been faced unusual presentation for the pseudoaneurysm of aortic arch,” during a surgical correction alone due to left-to-right Chest, vol. 144, no. 4, p. 143A, 2013. shunting [7]. Use of endovascular techniques for pseu- [6] L. A. Rodr´ıguez-Hidalgo, L. A. Concepcion-Urteaga, ´ doaneurysm closure has been shown to be feasible and safe, J. S. Hilario-Vargas, and D. C. Ruiz-Caballero, “Hemoptysis as helping to avoid complications that arise with high-risk a warning sign of thoracic aorta pseudoaneurysm: a case surgical repair. In this case, the patient’s history of a CABG report,” Medwave, vol. 21, no. 1, Article ID e8112, 2021. and radiation therapy predisposed him to the formation of a [7] P. Touˇsek, V. P. R. Koca, ˇ J. Ulman, J. Hlavicka, ˇ and M. Kolesar, “Use of Amplatzer occludes for treatment of thoracic pseudoaneurysm. Use of a 16 mm ASD Amplatzer aorto-pulmonary fistulas-case and review of the literature,” occlusion device deployed percutaneously proved to be a Expert Review of Medical Devices, vol. 14, no. 11, pp. 845–847, viable and safe option for the patient, resulting in successful occlusion with no residual contrast flow around the device [8] L. Carmans, P. De Meester, W. Budts, and E. Troost, “Per- on CTA one month following the procedure. cutaneous closure of an uncommon aortic pseudoaneurysm after arterial switch repair: a case report,” European Heart 4. Conclusion Journal-Case Reports, vol. 3, no. 4, pp. 1–4, 2019. [9] J. Stehli, F. S. Alie-Cusson, J. M. Panneton, and Although rare, hemoptysis has been described in few case P. D. Mahoney, “Percutaneous closure of iatrogenic ascending reports as the presenting symptom of thoracic pseudoa- aortic pseudoaneurysms following surgical aortic repair,” neurysms due to erosion of the surrounding airway and lung Journal of the American College of Cardiology: Case Reports, parenchyma, increased fragility and susceptibility to rupture vol. 3, no. 2, pp. 327–333, 2021. of surrounding bronchial arteries, formation of aorto- [10] J. Hussain, R. Strumpf, G. Wheatley, and E. Diethrich, “Percutaneous closure of aortic pseudoaneurysm by bronchial fistulas, or rupture. In this case, treatment with a Amplatzer occluder device-case series of six patients,” 16 mm ASD Amplatzer occlusion device resulted in reso- Catheterization and Cardiovascular Interventions, vol. 73, lution of the patient’s recurrent hemoptysis and avoidance of no. 4, pp. 521–529, 2009. high-risk surgical repair and its complications. [11] F. Bashir, R. Quaife, and J. D. Carroll, “Percutaneous closure of ascending aortic pseudoaneurysm using Amplatzer septal Data Availability occluder device: the first clinical case report and literature review,” Catheterization and Cardiovascular Interventions, No data were used to support this study. vol. 65, no. 4, pp. 547–551, 2005. [12] S. Delorme, P. Ruchat, and J. J. Goy, “Percutaneous treatment Conflicts of Interest of late complications of the Bentall procedure,” Catheteri- zation and Cardiovascular Interventions, vol. 92, no. 2, +e authors declare that they have no conflicts of interest. pp. 348–352, 2018. Authors’ Contributions All authors participated in drafting and revising the man- uscript critically for important intellectual content. Acknowledgments +is report was supported by the Department of Cardio- vascular Disease at Cleveland Clinic. References [1] L. F. Hiratzka, G. L. Bakris, J. A. Beckman et al., “ACCF/AHA/ AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease,” Circulation, vol. 121, no. 13, pp. 266–369, 2010. [2] Y. Kawatani, H. Kurobe, Y. Nakamura, Y. Suda, and T. Hori, “Aortic rupture due to radiation injury successfully treated with thoracic endovascular aortic repair,” Journal of Surgical Case Reports, vol. 2017, no. 5, pp. rjx092–4, 2017. [3] Y. Q. Lu, F. Yao, A. D. Shang, and J. Pan, “Pseudoaneurysm of the aortic arch: a rare case report of pulmonary cancer complication,” Medicine (Baltimore), vol. 95, no. 31, p. e4457,

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Journal of Interventional Cardiology – Hindawi Publishing Corporation

Published: Feb 11, 2022

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