title: Treatment of a giant ascending aortic pseudoaneurysm presenting as a presternal pulsatile protrusion almost perforating through the skin.
abstract: Aortic pseudoaneurysms have the potential for eroding bony structures in the chest, including the sternum, over time. Here, we report the case of a 54-year old woman with a giant pseudoaneurysm of the ascending aorta, 19 years after aortic root (mechanical conduit) and hemiarch replacement. The patient presented to her primary-care physician with a pulsatile presternal subcutaneous protrusion in the midline of her median sternotomy scar. We performed a challenging midline resternotomy after the establishment of a surgical safety net for cerebral and visceral organ protection followed by a supracoronary ascending and hemiarch replacement including a reinsertion of the coronary ostia employing selective antegrade cerebral perfusion and mild systemic hypothermic circulatory arrest. We discuss here the specific surgical considerations of this case.
authors: Division of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors: Ali
authors: A
authors: El-Sayed Ahmad
authors: Nestoras
authors: N
authors: Papadopoulos
authors: Anton
authors: A
authors: Moritz
authors: Andreas
authors: A
authors: Zierer
mesh_terms: D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002560:Cerebrovascular Circulation; D005260:Female; D006324:Heart Arrest, Induced; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D007036:Hypothermia, Induced; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D012086:Reoperation; D056346:Sternotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aortic operation; Cerebral protection; Reoperation