case_images: PMC7452561_01
case_images: Preoperative coronarography: (A) Coronary angiogram (CAG) shows 70% stenosis in the distal segment of the RCA, (B) Coronary angiogram (CAG) shows 75% stenosis of the the distal segment of the LAD, 80% and 75% stenosis, respectively in the mid and distal segments of the LCx, (CAG - coronary angiogram, LAD - left anterior descending coronary artery, RCA - right coronary artery, LCx - left circumflex coronary artery).
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case_images: Coronary angiography (CAG) showed left dominant coronary system with triple vessel coronary disease: 75% stenosis of the distal segment of left anterior descending coronary artery (LAD), left circumflex coronary artery (LCx) in the mid and distal segments had stenosis of 80% and 70%, respectively, and 70% stenosis of distal segment of the right coronary artery (RCA) (Fig. 1).
case_images: Preoperative contrast enhanced CT scan: (A) CT scan showing the AAP at the level of the aortic arch, (B) 3D CT-scan showing the AAP, with the neck present just caudally from LSA on the lesser aortic arch curvature. (AAP - aortic arch pseudoaneurysm, LSA - left subclavian artery).
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case_images: Apart from the complex lesions of the coronary arteries, 3D CT-scan revealed an AAP, with the neck present just caudally from the left subclavian artery (LSA) on the lesser aortic arch curvature which had a maximum diameter of 36 x 27 mm (Fig. 2).
case_images: Intraoperator view of aortic arch with Dacron patch repair.
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case_images: The aorta was first cross-clamped immediately after the origin of the LCA and a second clamp at the level of the aortic isthmus allowing us to perform the repair of the pseudoaneurysm on beating heart (Fig. 3).
case_images: (A) RCA CAG poststenting, (B) LCx CAG poststenting. (CAG - coronary angiogram, RCA - right coronary artery, LCx - left circumflex coronary artery).
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case_images: After weaning of CPB the PCI with DES was performed for the RCA, and LCx lesions (Fig. 4).
case_images: Multislice 3D reconstruction CT scan of the aortic arch after three months showing no evidence of filling or enlargement of the AAP. (AAP- aortic arch pseudoaneurysm).
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case_images: At three months after this procedure, a follow-up CT scan with 3D reconstruction was performed and revealed an excellent result, without residual arch pseudoaneurysm (Fig. 5).