Unusual Case of Giant Ascending Aortic Aneurysm Evolution of an Acute Aortic Dissection Type A Unoperated: A Case Report

Abstract

Survival after an acute aortic dissection type A unoperated is exceptional. We present the case of a 74-years-old male patient with multiple cardiovascular risk factors, presented mainly with severe dyspnoea of increasing intensity. Echocardiography and computer tomography angiography showed a large ascending aortic aneurysm (with a diameter of 10.8 cm) without aortic valve insufficiency, which started at 7 cm above the sinotubular junction, with a parietal thrombus occupying more than 30% of the circumference and its distal end at 5 cm after the aortic arch. This aneurysm was due to the evolution of an acute aortic dissection type A that was diagnosed five years prior to the current admission, which was not operated because the patient refused the surgical procedure at that time. Also, severe mediastinum displacement to the right with compression effect on the lung was revealed on the computer tomography. There are just a few cases in the literature diagnosed after acute aortic dissection type A unoperated who survived so long. In this context, he underwent surgical ascending aortic replacement with a prosthetic graft. The patient’s postoperative evolution was uneventful.