Ann Thorac Surg 2007;84:2118. doi:10.1016/j.athoracsur.2007.01.039
© 2007 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Giant Inflammatory Ascending Aorta Aneurysm
Velit Halit, MDa,
Erkan Ir
z, MDa,*,
Mustafa Hakan Zor, MDa,
Nalan Akyurek, MDb
a Department of Cardiovascular Surgery, Gazi University, School of Medicine, Ankara, Turkey
b Department of Pathology, Gazi University, School of Medicine, Ankara, Turkey
* Address correspondence to Dr Iriz, Gazi Üniversitesi Tp Fakültesi Kalp ve Damar Cerrahisi AD, Be
evler, Ankara, 06500, Turkey (Email: erkaniriz{at}hotmail.com).
A 49-year-old man was admitted to our hospital with precordial pain radiating to the left arm. A posteroanterior chest roentgenogram showed severe enlargement in heart shadow and upper mediastinum, and deviation in the trachea (Fig 1a). An echocardiogram revealed aortic insufficiency of the fourth degree and enlargement in the ascending aorta. A contrast computed tomographic scan showed an aortic diameter of 11 cm at its largest point with a length of 14 cm (Figs 1b, 1c). His coronary angiography was normal.
A median sternotomy was performed after femoral artery cannulation under general anesthesia. The ascending aorta was severely enlarged and was exerting pressure on the superior vena cava and the innominate vein (Fig 1d). The anterior and lateral walls of the ascending aorta aneurysm were particularly thick and dense due to the effect of the peripheral tissues. After cannulation, cardiopulmonary bypass was started. After cross clamping, a Benthall procedure was performed with a 30-mm Dacron-valved conduit, and the ascending aorta was replaced up to the proximal arcus aorta (Fig 2). The postoperative period was uneventful and the patient was discharged on postoperative day 8. Biopsy specimens taken from the ascending aorta showed findings of arteritis consistent with inflammatory aneurysm. In aorta biopsies, the adventitia and media were found to be thickened with lymphoid and plasma cell infiltration (Fig 3). No microorganism was detected in microbiological culture and serological specimens taken from the aneurysm pouch. The patient was treated for arteritis. The patient remains in good condition at postoperative month 8.
