Abstract
BackgroundThe long-term effects of some surgical treatment procedures of arch replacement for aortic dissection or aortic aneurysm are unknown.Case presentationThe present study reports the case of a 68-year-old man admitted to our hospital for aortic arch anastomotic pseudoaneurysm with concomitant aortic root enlargement and coronary artery stenosis. Eleven years ago, at the age of 56 years, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed a second total arch replacement, aortic root replacement, and coronary artery bypass, using a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery, and femoral vein prior to re-sternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation; however, he was discharged in good condition on the fiftieth postoperative day.ConclusionsThis case suggests that island reconstruction has the potential to cause arch anastomotic pseudoaneurysms, particularly after a long postoperative period.
Highlights
The long-term effects of some surgical treatment procedures of arch replacement for aortic dissection or aortic aneurysm are unknown.Case presentation: The present study reports the case of a 68-year-old man admitted to our hospital for aortic arch anastomotic pseudoaneurysm with concomitant aortic root enlargement and coronary artery stenosis
This case suggests that island reconstruction has the potential to cause arch anastomotic pseudoaneurysms, after a long postoperative period
We experienced a rare case of pseudoaneurysm in the arch anastomotic region in the eleventh year after a total arch replacement with island reconstruction
Summary
Along with recent progress in aortic surgery, the number of patients undergoing thoracic aortic aneurysm surgery has increased, with evident improvements in long-term performance [1, 2]. Case presentation A 68-year-old man was admitted to our hospital due to aortic arch anastomotic pseudoaneurysm with concomitant aortic root enlargement and coronary artery stenosis. Coronary angiography indicated that there was 99% stenosis of the left anterior descending coronary artery at #7, collateral circulation from the right coronary artery, and 75% stenosis of the left circumflex artery at #13 Based upon these observations, the patient underwent a repeat total arch replacement, aortic root replacement (i.e., Bentall procedure), and coronary artery bypass grafting [the left internal thoracic artery (LITA) and saphenous vein graft (SVG) were used]. An indwelling pacemaker was inserted on the 40 s postoperative day due to sick sinus syndrome and the patient was discharged from the hospital on the fiftieth postoperative day (Fig. 4). He has been visiting the hospital as an outpatient and is in favorable condition
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