VSD plug to close an Ascending aortic pseudo aneurysm

This month, we highlight the case of ascending aortic pseudo aneurysm closure in a female patient, s/p CABG and aortic valve replacement as well as composite graft for an ascending aortic aneurysm, presenting with NSTEMI treated by stenting. A widened mediastinum was found on chest X-Ray leading to an angiography CT-scan showing a pseudo-aneurysm of the ascending aorta at the level of the previous sutures of the graft that was referred to percutaneous closure after surgical turn-down.

Educational Objectives

• Learn how to prepare a VSD plug device.
• Learn how to deploy a VSD plug device.
• Learn the step-by-step approach to percutaneous closure of an aortic pseudo aneurysm.

Step-by-step procedure:

1) Access site:

• 8 Fr bi-femoral approach.

2) Step by step approach:

An AL1 8Fr guiding catheter was not able to engage the pseudoaneurysm at first prompting the operators to perform an aortography using a pigtail catheter.

A 6Fr Judkins Right guiding catheter was also not able to engage despite trials using coronary guidewires (Whisper ES and Sion Black).

An AL1 6Fr guiding catheter found the false lumen and was exchanged for an 8Fr MP guiding cathter using a Confida wire.

The VSD plug (8Fr) was prepared and advanced over the stylet to the level of the aneurysm neck.

Pullback was performed after deployment of the distal end until resistance was felt after which an aortogram confirmed the correct position followed by full deployment of the device and retrieval of the guiding catheter.

A final aortogram was performed confirming the good sealing of the aneurysm.

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