Case Report: A rare case of giant ascending aortic dissecting aneurysm requiring redo sternotomy for rescue

TL;DR

A 45-year-old woman with a rare giant aortic aneurysm underwent a complex redo surgery and was successfully treated.

Contribution

This case report presents a rare and successful surgical intervention for a giant ascending aortic dissecting aneurysm.

Findings

A successful redo sternotomy was performed for a giant ascending aortic dissecting aneurysm.

The patient was discharged on the ninth postoperative day with satisfactory imaging results.

The surgery involved complex techniques like the Cabrol method for coronary anastomosis.

Abstract

Here, we report a rare case of a 45-year-old female with a giant ascending aortic dissecting aneurysm (diameter >10 cm) who underwent a redo sternotomy for rescue.

The patient had aortic coarctation repair and mechanical aortic valve replacement 20 years earlier. Although the patient had significant surgical risks due to a low hemoglobin level and long-term warfarin use, urgent surgical intervention was deemed necessary. The surgery involved cannulating the femoral artery and vein, splitting the sternum, and carefully dissecting the aneurysm. A 23-mm valve conduit was implanted, and the left coronary ostium was transplanted. The right coronary ostium was anastomosed using the Cabrol technique.

The surgery was successful, with a total operative time of 4 h and 25 min, cardiopulmonary bypass time of 143 min, and aortic cross-clamp time of 78 min. Postoperatively, the patient experienced frequent episodes of cardiac arrest, which resolved with the implantation of a temporary pacing device. Postoperative imaging showed satisfactory results, and the patient was discharged on the ninth postoperative day.

This case reports the successful management of a complex and high-risk surgical scenario and provides valuable insight for similar cases.

Figures