Coronary Button Pseudoaneurysm Resolution After Aortic Root Replacement Upon Cessation of Anticoagulation

BACKGROUND: Anticoagulation after aortic surgery is associated with an elevated risk of pseudoaneurysm formation. CASE SUMMARY: We present an unusual case of a patient who, after a Bentall procedure, developed a right coronary button pseudoaneurysm after commencement of anticoagulation. After cessation of anticoagulation, serial computed tomography demonstrated complete resolution of this pseudoaneurysm, negating the need for reoperation. DISCUSSION: This case adds to the scant literature describing spontaneous resolution of post-Bentall pseudoaneurysms, particularly those involving the coronary buttons. To date, most reports emphasize percutaneous or surgical repair, and as such, data on benign courses under conservative management are sparse. TAKE-HOME MESSAGES: Anticoagulation may initiate and propagate early coronary button pseudoaneurysms after aortic root surgery. Not all pseudoaneurysms after aortic root surgery need to be treated with procedural intervention. Nonoperative management with computed tomography surveillance, cessation of anticoagulation, and strict blood pressure management should be considered for treatment of pseudoaneurysms.