CT Appearance of Thoracic Aortic Graft Complications
Baskaran Sundaram1,
Leslie Eisenbud Quint1,
Smita Patel1,
Himanshu J. Patel2 and
G. Michael Deeb2
1 Department of Radiology, University of Michigan Health System, 1500 E Medical
Center Dr., Box 0302, Ann Arbor, MI 48109-0302.
2 Division of Cardiothoracic Surgery, Department of Surgery, University of
Michigan Health System, Ann Arbor, MI.
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Fig. 1A —Total aortic root technique (modified Bentall). Drawing shows
complete resection of native aortic root. Prosthetic valved conduit is sutured
to aortic valve annulus in proximal aspect. Native coronary arteries are
reimplanted as buttons (arrows) in prosthesis.
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Fig. 2A —Inclusion root technique. Drawing shows bioprosthetic valved conduit
within native aortic root. Graft is anchored in proximal aspect with series of
interrupted sutures to horizontal plane at nadir of aortic annulus (curved
arrows). Buttons are resected from valved conduit for subsequent native
coronary artery reimplantation (straight arrows). Asterisks indicate
space where small perigraft contrast pools occur in some patients. Dashed line
indicates aortic valve plane.
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Fig. 2B —Inclusion root technique. Drawing shows running suture line
attaching distal aspect of valved conduit to aorta. Straight arrow indicates
site of coronary artery reimplantation; curved arrows, proximal graft
anastomosis.
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Fig. 2C —Inclusion root technique. Drawing shows completed repair. Unlike
total aortic root technique in Figure
1A,
1B, inclusion root technique
results in placement of valved conduit within native aortic root. Straight
arrow indicates site of coronary artery reimplantation; curved arrows,
proximal graft anastomosis.
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Fig. 3 —Drawing shows total aortic arch replacement with separate individual
great vessel anastomoses. Thick straight arrows indicate proximal and distal
aortic anastomoses. Anastomoses between graft side branches and native arch
vessels (thin straight arrows), graft cannulation site
(arrowhead), and sewn site of unused graft side branch site
(curved arrow) also are shown.
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Fig. 4A —56-year-old man 1 month after descending thoracic aortic graft
replacement for posttraumatic contained aortic rupture. Routine CT scan shows
minimal perigraft low-attenuation material (arrows). Arrowhead
indicates felt pledget at graft cannulation site.
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Fig. 4B —56-year-old man 1 month after descending thoracic aortic graft
replacement for posttraumatic contained aortic rupture. Axial (B) and
sagittal reformatted (C) CT scans 12 months after A show marked
increase in amount of perigraft low-attenuation material (arrows).
Patient, who had no symptoms and no clinical evidence of infection, was not
treated for this imaging finding. Arrowhead indicates felt pledget at graft
cannulation site.
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Fig. 4C —56-year-old man 1 month after descending thoracic aortic graft
replacement for posttraumatic contained aortic rupture. Axial (B) and
sagittal reformatted (C) CT scans 12 months after A show marked
increase in amount of perigraft low-attenuation material (arrows).
Patient, who had no symptoms and no clinical evidence of infection, was not
treated for this imaging finding. Arrowhead indicates felt pledget at graft
cannulation site.
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Fig. 5 —80-year-old woman 15 months after ascending aortic graft replacement
for aortic aneurysm. CT scan obtained because patient felt chest wall
heaviness reveals abnormal perigraft low-attenuation material
(arrows). Surgical drainage revealed purulent fluid.
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Fig. 6A —60-year-old man 1 month after porcine aortic root replacement for
type 1 aortic dissection. Routine follow-up axial (A and B) and
coronal reformatted (C) CT scans show small pockets of contrast
material (arrows) in space between inclusion root graft and
surrounding native aortic wrap, apparently arising from right coronary artery
button anastomosis. Appearance did not change on CT scans obtained over 5-year
period, and condition remained asymptomatic. Arrowhead (B) indicates
right coronary artery.
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Fig. 6B —60-year-old man 1 month after porcine aortic root replacement for
type 1 aortic dissection. Routine follow-up axial (A and B) and
coronal reformatted (C) CT scans show small pockets of contrast
material (arrows) in space between inclusion root graft and
surrounding native aortic wrap, apparently arising from right coronary artery
button anastomosis. Appearance did not change on CT scans obtained over 5-year
period, and condition remained asymptomatic. Arrowhead (B) indicates
right coronary artery.
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Fig. 6C —60-year-old man 1 month after porcine aortic root replacement for
type 1 aortic dissection. Routine follow-up axial (A and B) and
coronal reformatted (C) CT scans show small pockets of contrast
material (arrows) in space between inclusion root graft and
surrounding native aortic wrap, apparently arising from right coronary artery
button anastomosis. Appearance did not change on CT scans obtained over 5-year
period, and condition remained asymptomatic. Arrowhead (B) indicates
right coronary artery.
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Fig. 7A —47-year-old man taking anticoagulation therapy 27 months after
aortic arch replacement for chronic type A aortic dissection. Axial (A
and B) and sagittal reformatted (C) CT scans obtained because of
clinical suspicion of mediastinal hematoma and infection show active contrast
extravasation (white arrows) arising from cannulation site in graft
and extending into sternotomy defect in anterior chest wall. Leak and
infection at cannulation site were confirmed at subsequent surgical repair.
Straight black arrows indicate distal graft anastomosis; arrowhead (A),
felt pledget at cannulation site; curved arrows (A and B),
dissection flap in native aorta.
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Fig. 7B —47-year-old man taking anticoagulation therapy 27 months after
aortic arch replacement for chronic type A aortic dissection. Axial (A
and B) and sagittal reformatted (C) CT scans obtained because of
clinical suspicion of mediastinal hematoma and infection show active contrast
extravasation (white arrows) arising from cannulation site in graft
and extending into sternotomy defect in anterior chest wall. Leak and
infection at cannulation site were confirmed at subsequent surgical repair.
Straight black arrows indicate distal graft anastomosis; arrowhead (A),
felt pledget at cannulation site; curved arrows (A and B),
dissection flap in native aorta.
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Fig. 7C —47-year-old man taking anticoagulation therapy 27 months after
aortic arch replacement for chronic type A aortic dissection. Axial (A
and B) and sagittal reformatted (C) CT scans obtained because of
clinical suspicion of mediastinal hematoma and infection show active contrast
extravasation (white arrows) arising from cannulation site in graft
and extending into sternotomy defect in anterior chest wall. Leak and
infection at cannulation site were confirmed at subsequent surgical repair.
Straight black arrows indicate distal graft anastomosis; arrowhead (A),
felt pledget at cannulation site; curved arrows (A and B),
dissection flap in native aorta.
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Fig. 8A —76-year-old woman with unremitting sternotomy wound infection and
mediastinitis 12 months after ascending aorta and aortic arch replacement for
aortic aneurysm. CT scan shows small pockets of contrast extravasation
(curved black arrow) at graft anastomosis (arrowhead)
consistent with dehiscence. Finding was confirmed at surgery.
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Fig. 8B —76-year-old woman with unremitting sternotomy wound infection and
mediastinitis 12 months after ascending aorta and aortic arch replacement for
aortic aneurysm. CT scan shows tethering (curved arrow) of
midthoracic esophagus and mediastinal gas (straight arrow),
suggesting aortoesophageal fistula. Findings were confirmed at surgery.
Arrowheads indicate graft anastomosis
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Copyright © 2007 by the American Roentgen Ray Society.
