Case Report
A 53-year-old man was admitted to our hospital for the progressive enlargement of ascending aortic aneurysm (AAA) during serial follow-up. His clinical symptoms were intermittent cough and mild exertional dyspnea.
Chest radiography showed widened mediastinum and increased cardiothoracic ratio (Fig 1A). Transthoracic echocardiography revealed a giant AAA(11.3×9.7cm) with sinotubular junction effacement, compressing right atrium and tricuspid annulus (Fig 1B-1C). Computed tomography angiography confirmed the presence of AAA (12.3×11.5cm) (Fig 1D). It compressed the left and right atrium, and superior vena cava (Fig 1E). The volume-rendered three-dimensional image showed a huge AAA with a normal aortic arch and descending aorta (Fig 1F).
Surgical repair of this large AAA was recommended to prevent potentially life-threatening complications. A detailed transesophageal echocardiography was done intraoperatively. Apart from the giant AAA, pre-bypass transesophageal echocardiography revealed a rupture of the sinus of the Valsalva aneurysm with shunting into the right atrium. (Fig 2A) and bicuspid aortic valve. The rupture in the aneurysmal wall measuring 0.3cm was shown intuitively by a three-dimensional echocardiogram (Fig 2B). At operation, a giant AAA occupied almost the entire pericardial cavity (Fig 2C). The aortic valve was confirmed to have 2 leaflets, and a ruptured sinus of Valsalva was identified (Fig 2D). The patient underwent a successful Bentall procedure and the repair of a ruptured sinus of Valsalva. Weaning from cardiopulmonary bypass and postoperative course were uneventful,The patient was discharged from the hospital 10 days after surgery.