CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 1, January/February 2014
AFRICA
e1
Case Report
Chronic dissecting aneurysm of the ascending aorta
developed in a patient who had rejected surgical
treatment for type II acute ascending aortic dissection
three years earlier
Bi̇
lgehan Erkut, Ozgur Dag, Mehmet Ali̇
Kaygi̇
n, Husnu Kami̇
l Li̇
mandal, Ahmet Aydi̇
n, Eyup Serhat Cali̇
k
Abstract
A 66-year-old male patient was admitted to our clinic because
of shortness of breath and chest pain. A grade 4/6 diastolic
murmur was heard on auscultation. Physical examination
revealed signs of congestive heart failure and poor peripheral
perfusion. There was a diagnosis of type II ascending aortic
dissection in the history of the patient. He had refused emer-
gency surgical intervention three years earlier. Computed
tomography revealed that the ascending aorta was dilated to
about 10 cm in diameter, and there was a chronic aortic type
II dissection. The patient had second- to third-degree aortic
insufficiency and he had a calcified bicuspid aortic valve on
echocardiography. Two-vessel disease and a 90-mmHg aortic
gradient were detected on angiography. Graft replacement of
the ascending aorta, serape aortic valve replacement with a
mechanical valve, and coronary arterial bypass grafting were
performed successfully under cardiopulmonary bypass with
an open aortic technique. The patient was discharged on the
10th postoperative day with no problems.
Keywords:
chronic aortic dissection, aortic graft replacement,
aortic valve replacement, surgical treatment
Submitted 27/9/12, accepted 8/11/13
Cardiovasc J Afr
2014;
25
: e1–e4
DOI: 10.5830/CVJA-2013-079
Aortic dissection is considered chronic when the interval
between the onset of the acute symptoms and surgery exceeds
three weeks. This chronic form of dissection is rare because the
spontaneous evolution of the acute form is death in the majority
of cases. In cases not resulting in death and becoming chronic,
usually there is aortic wall enlargement due to blood flow at
the dissecting aortic section. This situation causes aneurysmal
enlargement over time. The diameter of the ascending aorta
continues to become larger until rupture occurs, or a diagnosis
is made because of clinical symptoms in cases in which the
aortic diameter broadens. Consequently, giant chronic dissecting,
ascending aortic aneurysms occur.
We present here one-stage repair for a patient with chronic
type II aortic dissection, extensive enlargement of the ascending
aorta, a calcified aortic valve, and coronary arterial disease.
Case report
This concerns the case of a 66-year-old man who had previously
been diagnosed with type II aortic dissection and who had
refused surgical intervention. Three years later, the patient was
hospitalised because of chest pain, shortness of breath, fatigue
and dizziness. A grade 4/6 diastolic murmur was heard on
auscultation.
Chest X-rays showed a right pleural effusion. Computed
tomography demonstrated a giant aneurysm of the ascending
aorta, and it clearly disclosed a chronic Stanford type A aortic
dissection compressing the native aorta (Fig. 1). Besides, there
was an intimal flap, enlarged patent false lumen and true lumen
with mural thrombus in the ascending aorta. The lesion was
approximately 10 cm in diameter, the largest ever reported,
and resulted from chronic aortic dissection. In transthoracic
echocardiography, the patient had second- to third-degree aortic
insufficiency and a calcified bicuspid aortic valve.
Coronary and aortic root angiography was carried out to
measure the aortic gradient and condition of the coronary artery.
On angiography, two-vessel disease (left anterior descending
and right coronary arterial disease), advanced aortic stenosis
(90-mmHg gradient), and second-degree aortic insufficiency
were detected. The patient was recommended for surgical
treatment for advanced-stage aortic stenosis, chronic dissecting
aortic aneurysm, and a coronary bypass. The patient consented
to surgery and its risks and underwent surgery.
After a sternotomy, the ascending aortic aneurysm was seen
(Fig. 2). First, the femoral artery and right atrium were prepared
for cardiopulmonary bypass, following systemic heparinisation
Department of Cardiovascular Surgery, Erzurum Regional
Training and Research Hospital, Erzurum, Turkey
Bi̇
lgehan Erkut, MD,
Ozgur Dag, MD
Mehmet Ali̇
Kaygin, MD
Husnu Kami̇
l Li̇
mandal, MD
Ahmet Aydi̇
n, MD
Eyup Serhat Cali̇
k, MD
