Safety and Effectiveness of Percutaneous Closure of Left Atrial Appendage in Patients With Intracranial Hemorrhage

aortoplasty of the aortic constricted segment is preferred by many surgeons as it potentially allows subsequent growth of the aortic wall and reduces the number of collaterals to be tied off. Several postoperative complications have been described, such as restenosis, aneurysm, and pseudoaneurysm, frequently developing many years after the intervention. Aneurysm and pseudoaneurysm may occur in up to 10% of patients, at a mean interval from operation superior to 12 years. In our patient, disruption of the aortic Dacron patch suture line was evident and clearly generated the pseudoaneurysm, composed of thrombotic material surrounded by fibrous and inflammatory tissue. The progressively expanding pseudoaneurysm, mainly in older patients, may compress and erode the pulmonary parenchyma, leading—as in our patient—to the aortopulmonary fistula. As previously observed, the present case confirms that sudden lipothymia, hemoptysis, and anemia could be clinical signs indicative of aortopulmonary fistula in patients who have undergone aortic coarctation repair even many decades earlier. Lifelong follow-up after coarctation aortoplasy is recommended.