Aneurysm of the nonpatent ductus arteriosus in the adult —A report of the case and review of the literature—

Abstract

Aneurysm of the ductus arterious in adult in rare. 28 cases have been previously reported in the Japanese literature. A new 73-year-old male case, preoperatively diagnosed and successfully repaired, are presented. The patient with hoarseness was admitted to our hospital. Contrast-enhanced CT scans and aortograms made a diagnosis for the aneurysm of the ductus arteriosus. Operation was done through left thoracotomy with the aid of partial cardiopulmonary bypass. The pulmonary arterial end of the ductus arteriosus was closed and a Ligamentum arteriosus was identified. A 3 by 2.7 cm saccular aneurysm was resected and segmental replacement of the aorta with woven dacron graft was performed. Because of it's critical location and the high incidence of complications, aneurysm of the ductus arteriosus in the adult should be surgically corrected when diagnosed.

Repair of a Ductal Aneurysm Using a Hemi-Clamshell Incision in an Elderly Patient

“…SDA in adults is rare [1][2][3][4][5][6] and presents few symptoms except for hoarseness. If left untreated, it can lead to serious vascular complications including rupture, thromboembolism, erosion into adjacent structures, and infection, in order of frequency.…”

“…2,3) As the aortic wall commonly does not express extensive atherosclerosis in SDA patients, aneurysmectomy followed by patch closure through a left lateral thoracotomy has been employed for most patients. [1][2][3][4][5] The left lateral thoracotomy approach was initially proposed for the patient of the current case report, but was decided against because the potential for the patient to require a total arch replacement was relatively high, based on the patient's age. 2,3) Moreover, the aberrant right subclavian artery can complicate the procedure.…”

“…[1][2][3][4][5] The left lateral thoracotomy approach was initially proposed for the patient of the current case report, but was decided against because the potential for the patient to require a total arch replacement was relatively high, based on the patient's age. 2,3) Moreover, the aberrant right subclavian artery can complicate the procedure. Thus, surgery via a left hemiclamshell incision was most appropriate in this particular case.…”

“…[1][2][3][4][5][6] Most patients undergo a left lateral thoracotomy, while a median sternotomy is recommended in only some cases requiring concomitant cardiac or aortic surgery. 1) Although one of the characteristics of SDA is the absence of severe changes in atherosclerotic vessel morphology, more extensive surgery is necessary when the patient exhibits extensive atherosclerosis, as is commonly seen in elderly patients.…”

“…1) Although one of the characteristics of SDA is the absence of severe changes in atherosclerotic vessel morphology, more extensive surgery is necessary when the patient exhibits extensive atherosclerosis, as is commonly seen in elderly patients. 2,3) The current report describes the repair of a ductal aneurysm in an elderly patient via the hemi-clamshell approach.…”