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

Göncü T, Sezen M, Ari H, Tiryakioglu O, Yumun G, Yavuz S - Case Rep Med (2010)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey.

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.

No MeSH data available.


Related in: MedlinePlus

(a) Chest X-ray imaging showing as an aortic enlargement. (b) Spiral thoracic computed tomography imaging showing as a 16-cm aneurysm of ascending aorta. (c) The aortic aneurysm was occupying most of the space in the pericardial cavity. (d) and (e) The aneurysm of the ascending aorta was resected and implanted with a woven graft associated with the left and right coronary artery button implantation.
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fig1: (a) Chest X-ray imaging showing as an aortic enlargement. (b) Spiral thoracic computed tomography imaging showing as a 16-cm aneurysm of ascending aorta. (c) The aortic aneurysm was occupying most of the space in the pericardial cavity. (d) and (e) The aneurysm of the ascending aorta was resected and implanted with a woven graft associated with the left and right coronary artery button implantation.

Mentions: A 28-year-old man with severe aortic regurgitation underwent aortic valve replacement with a mechanical prosthetic valve about 10 years ago. At the time of this operation the ascending aorta was slightly dilated and measured as 3.4 cm. An ascending aortic aneurysm was suspected with chest X-ray in routine follow-up of the patient who had not been controlled until that time (Figure 1(a)). Echocardiography and chest-enhanced computed tomography revealed a giant ascending aortic aneurysm about 16 cm in diameter with intact aortic arch (Figure 1(b)). Prosthetic valve function and other cardiac structures were assessed as normal with two-dimensional and color Doppler examination. An elective operation was planned for the aortic aneurysm. The operation was performed under cardiopulmonary bypass, established by cannulation of the right femoral artery and right atrium via the right femoral vein. Cardiopulmonary bypass was started before sternotomy to decompress the aneurysm. Chest was opened with a median resternotomy. A giant ascending aortic aneurysm was occupying most of the space in the pericardial cavity, with the heart lying posteriorly (Figure 1(c)). The aortic arch was not found to be involved. After careful dissection of the aneurysm we were able to cross clamp the aorta proximally to the brachiocephalic trunk. After cross-clamping, the aorta was opened and cardioplegic solution was infused into each coronary artery. The previously implanted valve prosthesis was intact and assessment of valve functions was normal. Aneurysm of the ascending aorta was resected leaving the functional old mechanical prosthesis in place and we implanted a 34-mm Hemashield woven graft (Meadox Medicals Inc, Oakland, NJ, USA), associated with the left and right coronary artery button implantation. Distal anastomosis of the aortic graft was performed under aortic cross clamp (Figures 1(d) and 1(e)). Aortic clamping time was 117 minutes. Weaning from cardiopulmonary bypass and the postoperative course was uneventful. The patient was discharged without complication 10 days after surgery. Marfan syndrome was clinically excluded. Histological findings of the aortic aneurysm wall showed cystic medial necrosis (Figure 2).


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

Göncü T, Sezen M, Ari H, Tiryakioglu O, Yumun G, Yavuz S - Case Rep Med (2010)

(a) Chest X-ray imaging showing as an aortic enlargement. (b) Spiral thoracic computed tomography imaging showing as a 16-cm aneurysm of ascending aorta. (c) The aortic aneurysm was occupying most of the space in the pericardial cavity. (d) and (e) The aneurysm of the ascending aorta was resected and implanted with a woven graft associated with the left and right coronary artery button implantation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2821656&req=5

fig1: (a) Chest X-ray imaging showing as an aortic enlargement. (b) Spiral thoracic computed tomography imaging showing as a 16-cm aneurysm of ascending aorta. (c) The aortic aneurysm was occupying most of the space in the pericardial cavity. (d) and (e) The aneurysm of the ascending aorta was resected and implanted with a woven graft associated with the left and right coronary artery button implantation.
Mentions: A 28-year-old man with severe aortic regurgitation underwent aortic valve replacement with a mechanical prosthetic valve about 10 years ago. At the time of this operation the ascending aorta was slightly dilated and measured as 3.4 cm. An ascending aortic aneurysm was suspected with chest X-ray in routine follow-up of the patient who had not been controlled until that time (Figure 1(a)). Echocardiography and chest-enhanced computed tomography revealed a giant ascending aortic aneurysm about 16 cm in diameter with intact aortic arch (Figure 1(b)). Prosthetic valve function and other cardiac structures were assessed as normal with two-dimensional and color Doppler examination. An elective operation was planned for the aortic aneurysm. The operation was performed under cardiopulmonary bypass, established by cannulation of the right femoral artery and right atrium via the right femoral vein. Cardiopulmonary bypass was started before sternotomy to decompress the aneurysm. Chest was opened with a median resternotomy. A giant ascending aortic aneurysm was occupying most of the space in the pericardial cavity, with the heart lying posteriorly (Figure 1(c)). The aortic arch was not found to be involved. After careful dissection of the aneurysm we were able to cross clamp the aorta proximally to the brachiocephalic trunk. After cross-clamping, the aorta was opened and cardioplegic solution was infused into each coronary artery. The previously implanted valve prosthesis was intact and assessment of valve functions was normal. Aneurysm of the ascending aorta was resected leaving the functional old mechanical prosthesis in place and we implanted a 34-mm Hemashield woven graft (Meadox Medicals Inc, Oakland, NJ, USA), associated with the left and right coronary artery button implantation. Distal anastomosis of the aortic graft was performed under aortic cross clamp (Figures 1(d) and 1(e)). Aortic clamping time was 117 minutes. Weaning from cardiopulmonary bypass and the postoperative course was uneventful. The patient was discharged without complication 10 days after surgery. Marfan syndrome was clinically excluded. Histological findings of the aortic aneurysm wall showed cystic medial necrosis (Figure 2).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey.

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.

No MeSH data available.


Related in: MedlinePlus