Delayed Presentation of a Giant Ascending Aortic Aneurysm following Aortic Valve Replacement

Abstract

Giant ascending aortic aneurysm formation following aortic valve replacement is rare. A 28-year-old man who underwent aortic valve replacement with a prosthetic valve for aortic regurgitation secondary to congenital bicuspid aortic valve about 10 years ago was diagnosed with a giant ascending aortic aneurysm about 16 cm in diameter in follow-up. The aneurysm was resected leaving the functional old mechanical prosthesis in place and implanted a 34-mm Hemashield woven graft, associated with the left and right coronary artery button implantation. Histological findings of the aortic aneurysm wall showed cystic medial necrosis. The postoperative course was uneventful and postoperative examination demonstrated good surgical results.

A huge saccular aortic aneurysm compressing right coronary artery 7 years after aortic valve replacement due to bicuspid aortic valve insufficiency

“…[ 5 ] Development of large, delayed-typed aneurysmal change following AVR has been previously reported. [ 6 ]…”

The Largest Operated Ascending Aortic Aneurysm in a Patient Without a History of Cardiac Surgery

“…An ascending aortic aneurysm of size 80 x 107 x 140 mm was detected in a 53-year-old female patient and was reported by Shah et al [ 5 ] However, this patient could not be operated because the patient did not accept the procedure. In 2009, a huge ascending aortic aneurysm was reported by Goncu et al [ 6 ] - an aneurysm reaching to 16 cm in diameter in a 28-year-old male patient. This patient, who underwent mechanical prosthetic aortic valve operation 10 years ago, underwent ascending aortic replacement accompanied by coronary button anostomosis.…”

“…In this patient, Marfan syndrome was clinically excluded and the pathological diagnosis was detected as cystic medial necrosis. The patient was discharged on the 10 th day after the operation with healing [ 6 ] . In the light of all this information, it may be more accurate to describe this current case reported by Bicer et al [ 6 ] as “The largest operated ascending aortic aneurysm in a patient without a history of cardiac surgery”.…”