[A case of thoracic endovascular aortic repair using a transapical approach through the left ventricular apex for an ascending aortic pseudoaneurysm].

We report a case of a patient with two previous histories of resection of thymoma using median sternotomy and repair for an ascending aortic pseudoaneurysm using median thoracotomy undergoing endovascular aortic repair of the recurrence of pseudoaneurysm in the same site. Due to severe adhesion and calcification in the tissue after two histories of thoracotomy, we expected it impossible to repair the pseudoaneurysm with open thracotomy. We concluded that endovascular aortic repair was the best way for the case. Only problem was the limitation of the characters of current devices for thoracic endovascular aortic repair. If the procedure is done in the ordinary way, the tips of stent graft delivery systems are so long that there may be a danger of damaging the aortic valve, coronary artery, and left ventricle. This is why we decided to use a transapical approach through the left ventricular apex by using left thoracotomy. For the operation, an arterial line and central venous line were secured and one-lung ventilation was performed. We used femoral-femoral bypass to prepare for unexpected bleeding. During the deployment of the stent graft, ventricular fibrillation was produced by the fibrillator to locate in the appreciate site. In the end, the operation was successful.