Ascending Aortic False Aneurysm Formation Associated with Rupture of Acute Type A Aortic Dissection

Abstract

A 63-year-old man with ruptured acute type A aortic dissection was referred to our hospital. Computed tomography showed a false aneurysm arising from the false lumen located beside the ascending aorta. His hemodynamic status was stable inspite of the ruptured acute aortic dissection. We consider that the containment of the false aneurysm by thin mediastinal structures prevented worsening of his hemodynamic status, and this is extremely rare.Keywords: aneurysm, aortic dissection, aortic operation surgery. When he arrived at our hospital, his hemodynamic status was stable, his blood pressure was 110/78 mmHg and his heart rate was 78 beats/min (regular). CT fi lms from the referring hospital showed pericardial effusion and a ruptured type A aortic dissection with a primary entry tear in the distal aortic arch (Fig. 1A). In addition, there was a false aneurysm arising from the false lumen that was enhanced in the early phase (Fig. 1B). The false aneurysm was located beside the ascending aorta and expanding into the transverse sinus (Fig. 1C, D). We performed an emergency operation. After median sternotomy, the pericardial cavity was found to be fi lled with old blood, and there was no pericardial adhesion. Total cardiopulmonary bypass was initiated with retrograde perfusion through the femoral artery and bicaval venous drainage with left ventricular venting. After antegrade cold blood cardioplegia was selectively administered, cardiac arrest was obtained. However we could not fi nd the tear of adventitia which had caused the false aneurysm, we could identify the false aneurysm surrounded by connective tissue and hematoma. We thought that the tear of adventitia was located in the ascending aorta because adventitia of the aortic root was not ruptured. The transected proximal stump of the ascending aorta was reconstructed with both inner and outer Tefl on felt. He was cooled to 28°C, the ascending aorta was opened and selective antegrade cerebral perfusion was established. We performed total arch replacement using Dacron graft. Thoracic endovascular aortic repair was performed to close the primary entry 12 days after the surgery. The false aneurysm was not seen on the postoperative CT (Fig. 2), and his postoperative course was satisfactory. DiscussionFalse aneurysm is a rare and life threatening complication that occurs in 0.5% of all cardiac surgical cases. 2) False aneurysm of the thoracic aorta results from transmural disruption of the aortic wall and is contained by the surrounding mediastinal structures. When the pressure in the

Ruptured pseudoaneurysm of the thoracic aorta mimicking lung cancer: A case report

“…PTA is a rare complication of aortic surgery that occurs in less than 0.5% of cardiac surgery cases. PTA may also occur secondarily after infection or trauma, but its exact frequency remains unclear 5–7 …”